Transrectal Ultrasound-Guided Prostatic Biopsy: Midazolam, the Ideal Analgesic

Abstract

Objectives: Patients with raised serum prostate-specific antigen and/or an abnormal-feeling prostate were subjected to transrectal ultrasound-guided prostatic biopsy to rule out any prostatic malignancy. There are many methods for pain relief and to treat discomfort during the procedure but we compared the efficacy of intravenous (IV) midazolam for pain control. Patients and Methods: This was a prospective study of 50 patients. All patients underwent a ten quadrant biopsy. The patients were divided into two groups: group 1 (study group) which included 25 patients who used 1 ml of IV midazolam and group 2 (control group) which included 25 patients who did not use IV midazolam. Results: In group 1, of 25 patients only 1 patient had mild pain (VAS 2) during and after the procedure. In group 2, of 25 patients, 15 patients had pain during the procedure. Conclusion: Midazolam is a benzodiazepine derivative with an anxiolytic, sedative, amnestic and hypnotic action. Our study shows that using midazolam is a very simple technique which gives excellent analgesia and no other analgesia was required. No monitoring was needed, there was a very low incidence of complications and it did not require any technical expertise.

Efficacy and cost analysis of transrectal ultrasound-guided prostate biopsy under monitored anesthesia

“…In patients with elevated serum PSA level and/or an abnormal-feeling prostate on exam, TRUSguided prostatic biopsy is routinely performed to diagnose the presence or absence of malignancy. 10 Recently, the performance of multiple-core prostatic biopsies has become standard practice, and repeat biopsies are often performed despite initial negative histology. There is a general consensus regarding the necessity of some form of anesthesia during TRUS-guided prostate biopsy due to preoperative pain and/or discomfort.…”

“…However, they admitted that caudal injection was an additional procedure that caused extra discomfort. Shrimali et al 10 reported that the use of midazolam was both simple and resulted in excellent analgesic effects. In a separate study, researchers also reported that midazolam was an effective alternative for increasing patient comfort during TRUS-guided prostate biopsy, especially in clinical situations including patient anxiety, young age, repeat biopsies or inflammatory anal diseases.…”

Does Washing the Biopsy Needle with Povidone-Iodine Have an Effect on Infection Rates after Transrectal Prostate Needle Biopsy?

“…Therefore noninvasive anesthetic methods were tried. The Shrimali et al [15] study showed that IV midazolam is an effective and reliable agent for pain control. It is not yet clear how many core biopsies must be taken during biopsy.…”

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

“…The most commonly used sedatives are midazolam and propofol [15,16]; however, midazolam did not achieve deep sedation in most studies, and it is not easy to clinically adjust the level of sedation with bolus administration.…”