Current methods of analgesia for transrectal ultrasonography (TRUS)‐guided prostate biopsy – a systematic review

Abstract

Transrectal ultrasonography (TRUS)‐guided prostate biopsy is the most commonly used method of sampling prostate tissue for the diagnosis of prostate cancer. The technique is well recognised to potentially cause severe pain and discomfort for patients and this has led to numerous attempts to devise ways to minimise these problems. This systematic review summarises the techniques that have been described to date, with special reference to studies using either a visual analogue or numerical analogue scale to report outcomes. Commonly used approaches that are effective to minimise pain or discomfort include intravenous sedoanalgesia, inhalational agents and periprostatic infiltration of local anaesthetic. Whilst diclofenac suppositories are more effective than placebo, intra‐rectal local anaesthetic gels appear to be of no benefit. Performing TRUS‐guided prostate biopsy without any form analgesia is not appropriate.

Lateral decubitus position vs. lithotomy position: which is the best way to minimize patient’s pain perception during transrectal prostate biopsy?

“…After initial biopsy, the number of patients who requires repeat biopsy also grows with the increased life span and widespread use of active surveillance as a recommendable clinical option in management of low risk prostate cancer (3). In addition, along with increasing incidence of biopsy led by increased public awareness of the disease as well as escalation of biopsy cores obtained, the number of subjects who consider the procedure uncomfortable and painful is also increasing (4). Thus, efforts to minimize the discomfort associated with the procedure are crucial not only in detection, but also in a proper control of the disease through the patient’s life expectancy.…”

Prostat Biyopsisi Öyküsü Olan Hastalarda Transrektal Ultrason Kılavuzluğunda Yapılan Prostat Rebiyopsisi Sırasında Ağrı Skorları Değişiyor mu?

“…TRUS-PBx, kanser tespit olasılığını artırmanın yanı sıra aktif izlem yapılan hastaların takibi nedeniyle yapılan tekrar biyopsi sayısındaki artışa bağlı olarak yaygın olarak uygulanmaktadır (12). Eğer bu işlem herhangi bir analjezi ya da anestezi uygulaması yapılmaksızın gerçekleştirilirse hastalarda ağrıya ve rahatsızlığa neden olmaktadır (3).…”

The effects of meperidine in patients undergoing deep sedation for transrectal ultrasound-guided prostate biopsy: a randomized, controlled, double-blind study

“…The performance of TRUS-PBx without discomfort allows a greater number of samples to be collected leading to a higher biopsy success rate. It is now well accepted that some form of anesthesia should be administered when performing TRUS-PBx [4].…”

“…Although various anesthetic methods for TRUS-PBx have been investigated [2,4,5], there is no consensus regarding an optimal anesthetic technique. Deep sedation can achieve sufficient anxiolysis and prevent movement during the procedure, but may also cause adverse side effects.…”