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Atta H, Mostafa MF, Shalaby M. Which is better for pain reduction during transrectal ultrasound-guided biopsy of the prostate: Intravenous diazepam, local periprostatic nerve block, or combination? controlled randomized study. Saudi J Anaesth 2018; 12:16-21. [PMID: 29416451 PMCID: PMC5789491 DOI: 10.4103/sja.sja_141_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Transrectal ultrasound-guided prostate biopsy (TRUSPB) is considered the procedure of choice for the diagnosis of prostate cancer. Men undergoing this biopsy experience high psychological stress. Different studies recommend techniques as sedation, lidocaine gel intrarectally, periprostatic nerve block alone, or nitrous oxide inhalation as effective methods of analgesia during procedural-related pain or discomfort. We evaluated three techniques for pain relief during TRUSPB and evaluated if there was any increase in the incidence of complications when employing either technique. Setting: Assiut University Hospital, Assiut, Egypt. Methods: Three hundred patients of age 43–92-year-old underwent TRUSPBs. Patients were allocated randomly into three equal groups to receive intravenous (IV) diazepam 5 mg slowly (Group I), bilateral periprostatic nerve block by 10 ml of 1% lidocaine solution injected under ultrasound guidance (Group II), or combined IV diazepam and the periprostatic nerve block (Group III). Results: The mean pain score was 4.95 for patients in Group I, 4.15 for patients in Group II, and 2.18 for patients in Group III with statistically significant findings (F = 120.27, P < 0.001). TRUSPB under combined IV sedation and local anesthesia had no significant increase in the incidence of complications. Conclusions: Patients should have analgesia during TRUSPB to decrease the procedure pain and to improve tolerance permitting proper aiming for biopsy cores without increasing the patient distress. The combined IV sedation and local periprostatic nerve block are efficient in controlling and limiting pain better than employing each technique alone with no significant increase in complications incidence.
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Affiliation(s)
- Haisam Atta
- Department of Radiology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Mohamed F Mostafa
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University Hospital, Assiut University, Assiut, Egypt
| | - Mahmoud Shalaby
- Department of Urology, Faculty of Medicine, Assiut University Hospital, Assiut University, Assiut, Egypt
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Zhuo H, Jin H, Peng H, Huang H. Distribution, pharmacokinetics and primary metabolism model of tramadol in zebrafish. Mol Med Rep 2016; 14:5644-5652. [DOI: 10.3892/mmr.2016.5956] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 10/12/2016] [Indexed: 11/05/2022] Open
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Kilic O, Akand M, Kulaksizoglu H, Haliloglu AH, Tanidik S, Piskin MM, Yurdakul T. Intravenous paracetamol for relief of pain during transrectal-ultrasound-guided biopsy of the prostate: A prospective, randomized, double-blind, placebo-controlled study. Kaohsiung J Med Sci 2015; 31:572-9. [PMID: 26678937 DOI: 10.1016/j.kjms.2015.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 09/07/2015] [Accepted: 09/04/2015] [Indexed: 10/22/2022] Open
Abstract
Transrectal-ultrasound-guided prostate biopsy (TRUS-PBx) is the standard procedure for diagnosing prostate cancer. The procedure does cause some pain and discomfort; therefore, an adequate analgesia is necessary to ensure patient comfort, which can also facilitate good-quality results. This prospective, randomized, double-blinded, placebo-controlled study aimed to determine if intravenous (IV) paracetamol can reduce the severity of pain associated with TRUS-PBx. The study included 104 patients, scheduled to undergo TRUS-PBx with a suspicion of prostate cancer, that were prospectively randomized to receive either IV paracetamol (paracetamol group) or placebo (placebo group) 30 minutes prior to TRUS-PBx. All patients had 12 standardized biopsy samples taken. Pain was measured using a 10-point visual analog pain scale during probe insertion, during the biopsy procedure, and 1 hour postbiopsy. All biopsies were performed by the same urologist, whereas a different urologist administered the visual analog pain scale. There were not any significant differences in age, prostate-specific antigen level, or prostate volume between the two groups. The pain scores were significantly lower during probe insertion, biopsy procedure, and 1 hour postbiopsy in the paracetamol group than in the placebo group. In conclusion, the IV administration of paracetamol significantly reduced the severity of pain associated with TRUS-PBx.
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Affiliation(s)
- Ozcan Kilic
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Murat Akand
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey.
| | - Haluk Kulaksizoglu
- Department of Urology, School of Medicine, Bilim University, Istanbul, Turkey
| | - Ahmet H Haliloglu
- Department of Urology, School of Medicine, Ufuk University, Ankara, Turkey
| | - Seher Tanidik
- Department of Biochemistry, Medicana Hospital, Konya, Turkey
| | - Mehmet M Piskin
- Department of Urology, Meram Medical School, Necmettin Erbakan University, Konya, Turkey
| | - Talat Yurdakul
- Department of Urology, Kolan International Hospital Şişli, Istanbul, Turkey
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Kucur M, Goktas S, Kaynar M, Apiliogullari S, Kilic O, Akand M, Gul M, Celik JB. Selective Low-Dose Spinal Anesthesia for Transrectal Prostate Biopsy: A Prospective and Randomized Study. J Endourol 2015; 29:1412-7. [PMID: 26176605 DOI: 10.1089/end.2015.0450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To evaluate the use of spinal anesthesia by reducing anesthetic agent dose to provide better analgesia with minimal side effects without sacrificing the outpatient setting for prostate biopsy. In this study, efficacy and tolerability of selective low-dose spinal anesthesia versus intrarectal local anesthesia (IRLA) plus periprostatic nerve blockade (PPNB) were compared. METHODS Between September 2012 and April 2013, 100 patients, aged 40 to 80 years, prostate-specific antigen (PSA) ≥4 ng/mL, abnormal digital rectal examinations, and enrolled for biopsy were included in the present study. Ensuring double blindness, pain was assessed using the visual analog scale (VAS). Anal sphincter relaxation, patient satisfaction with the anesthesia technique, and motor response were evaluated. RESULTS Differences between the two groups, considering age, American Society of Anesthesiologist score, total PSA, prostate volume, anesthesia duration, and cancer presence, were not statistically significant. Pain experienced during probe insertion, biopsy, and 30 minutes after biopsy was significantly lower in the low-dose spinal anesthesia group (P < 0.0001). Anal sphincter relaxation degree was significantly higher in the spinal group (P < 0.001). Patient procedure-related overall satisfaction level was significantly higher in the spinal anesthesia group (P < 0.001). In the spinal anesthesia group, no motor blockade was observed. Between the two groups, no statistically significant difference was seen with regard to complications (P > 0.05). CONCLUSION Selective low-dose spinal anesthesia provides better pain relief than PPNB plus IRLA without sacrificing the day case setting in ambulatory practice. It is also associated with high patient satisfaction and willingness for a repeated biopsy without differences in procedure duration, tolerance, and complications.
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Affiliation(s)
- Mustafa Kucur
- 1 Department of Urology, Batman State Hospital , Batman, Turkey
| | - Serdar Goktas
- 2 Department of Urology, Selcuk University , Konya, Turkey
| | - Mehmet Kaynar
- 2 Department of Urology, Selcuk University , Konya, Turkey
| | - Seza Apiliogullari
- 3 Department of Anesthesia and Intensive Care, Faculty of Medicine, Selcuk University , Konya, Turkey
| | - Ozcan Kilic
- 2 Department of Urology, Selcuk University , Konya, Turkey
| | - Murat Akand
- 2 Department of Urology, Selcuk University , Konya, Turkey
| | - Murat Gul
- 4 Department of Urology, Van Education and Research Hospital , Van, Turkey
| | - Jale Bengi Celik
- 3 Department of Anesthesia and Intensive Care, Faculty of Medicine, Selcuk University , Konya, Turkey
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Lee C, Woo HH. Penthrox inhaler analgesia in transrectal ultrasound-guided prostate biopsy. ANZ J Surg 2014; 85:433-7. [DOI: 10.1111/ans.12694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Chanyang Lee
- Summer Research Scholarship; The University of Sydney; Sydney New South Wales Australia
- Sydney Adventist Hospital Clinical School; The University of Sydney; Sydney New South Wales Australia
| | - Henry H. Woo
- Sydney Adventist Hospital Clinical School; The University of Sydney; Sydney New South Wales Australia
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Ripamonti CI, Bossi P, Santini D, Fallon M. Pain related to cancer treatments and diagnostic procedures: a no man's land? Ann Oncol 2014; 25:1097-106. [PMID: 24625453 DOI: 10.1093/annonc/mdu011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND While guidelines are available for the management of cancer-related pain, little attention is given to the assessment and treatment of pain caused by treatments and diagnostic procedures in cancer patients. METHODS We evaluated the literature on pain related to cancer treatment and diagnostic procedures within a critical analysis. RESULTS The data available are sparse, suggesting that little attention has been directed at this important aspect of oncology. This points to potentially suboptimal patient management. CONCLUSIONS Appropriate studies are necessary in order to understand the incidence and appropriate management of pain, both during and/or after oncological treatments and diagnostic procedures. At the same time, Health Care Professionals should have heightened awareness of the causes and treatment of pain with the aim of anticipating and managing pain most appropriately for each individual patient. This is clearly an important component of holistic patient care before, during, and after oncological treatment.
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Affiliation(s)
- C I Ripamonti
- Supportive Care in Cancer Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan
| | - P Bossi
- Head and Neck Medical Oncology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan
| | - D Santini
- Medical Oncology Unit, Università Campus Bio-Medico, Rome, Italy
| | - M Fallon
- St Columba's Hospice Chair of Palliative Medicine, IGMM, University of Edinburgh, Edinburgh, UK
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Lee C, Woo HH. Current methods of analgesia for transrectal ultrasonography (TRUS)-guided prostate biopsy - a systematic review. BJU Int 2014; 113 Suppl 2:48-56. [DOI: 10.1111/bju.12433] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chanyang Lee
- Sydney Adventist Hospital Clinical School; University of Sydney; Sydney NSW Australia
| | - Henry H. Woo
- Sydney Adventist Hospital Clinical School; University of Sydney; Sydney NSW Australia
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Wang JJ, Huan SKH, Hsieh KH, Chou HC, Hsiao G, Jayakumar T, Sheu JR. Inhibitory effect of midazolam on MMP-9, MMP-1 and MMP-13 expression in PMA-stimulated human chondrocytes via recovery of NF-κB signaling. Arch Med Sci 2013; 9:332-9. [PMID: 23671446 PMCID: PMC3648813 DOI: 10.5114/aoms.2012.30949] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 11/15/2011] [Accepted: 12/05/2011] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Midazolam, a benzodiazepine, has a hypnotic effect and is widely used as an intravenous sedative. Past studies have clearly established that midazolam has beneficial effects in attenuating ischemia-reperfusion injury more than other currently used sedative drugs. However, the role of midazolam on chondroprotection via inhibition of matrix metalloproteinases (MMPs) is warrant investigation. The aim of this study was to examine the mechanisms of action of midazolam on MMP expression via nuclear factor κB (NF-κB) signaling in activated chondrosarcoma cells maintained in vitro. MATERIAL AND METHODS Chondrocytes, SW1353 cells, were stimulated with phorbol 12-myristate 13-acetate (PMA) in the absence or presence of various concentrations of midazolam (5-20 µM). Release of MMP-9 into the culture media was determined by gelatin zymography. The expressions of MMP-1, MMP-9 and MMP-13, phosphorylation of extracellular signal-regulated kinase (ERK), p38 mitogen-activated protein kinases and degradation of IκB-α were determined by western blotting assay. RESULTS Midazolam significantly down-regulated PMA-induced MMP-9 protein expression at concentrations of 5, 10 and 20 µM, the values were 1.95 ±0.09 (p < 0.01), 1.71 ±0.12 (p < 0.01) and 1.35 ±0.20 (p < 0.001), respectively. At concentrations of 5, 10 and 20 µM, it was significantly inhibited the PMA-induced expressions of MMP-1 (2.27 ±0.10, 1.98 ±0.11 and 1.56 ±0.15; p < 0.001) and MMP-13 (0.89 ±0.04, 0.81 ±0.07, and 0.74 ±0.09; p < 0.001), respectively. Midazolam at concentrations of 10 and 20 µM for 15 min significantly reversed the rate of degradation (0.895 ±0.051; p < 0.05 and 0.926 ±0.060; p < 0.01, respectively) of IκB-α in PMA-chondrocyte cells. In addition, this sedative drug inhibited PMA-induced levels of phos-ERK (1.243 ±0.12, 1.108 ±0.16 and 0.903 ±0.19, respectively) and phos-p38 (1.146 ±0.10, 1.063 ±0.13 and 0.946 ±0.18, at concentrations of (5, 10 and 20 µM), respectively. CONCLUSIONS These results are important for understanding the mechanism of midazolam in inhibiting PMA-induced MMP expression through the signaling pathways of either NF-κB or ERK/p38 MAPKs down-regulation.
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Affiliation(s)
- Jen-Jui Wang
- Department of Anesthesiology, West Garden Hospital, Taipei, Taiwan
| | - Steven Kuan-Hua Huan
- Division of Urology, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
| | | | - Hsiu-Chu Chou
- Department of Anatomy, and Graduate Institute of Medical Sciences, Taipei Medical University, Taiwan
| | - George Hsiao
- Department of Pharmacology and Graduate Institute of Medical Sciences, Taipei Medical University, Taiwan
| | - Thanasekaran Jayakumar
- Department of Pharmacology and Graduate Institute of Medical Sciences, Taipei Medical University, Taiwan
| | - Joen-Rong Sheu
- Department of Pharmacology and Graduate Institute of Medical Sciences, Taipei Medical University, Taiwan
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