Mahidol University, Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Bangkok, Thailand.
Mahidol University, Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Bangkok, Thailand.
Braz J Anesthesiol. 2021 Jul-Aug;71(4):345-351. doi: 10.1016/j.bjane.2021.02.001. Epub 2021 Feb 3.
Postoperative pain from transrectal ultrasound-guided prostate (TRUS-P) biopsy under sedation is often mild. Benefit of opioids used during sedation is controversial.
The objective was to compare numeric rating scale (NRS) score at 30 minutes after TRUS-P biopsy between patients receiving propofol alone or with fentanyl.
We randomly allocated 124 patients undergoing TRUS-P biopsy to receive either fentanyl 0.5 mcg.kg (Group F) or normal saline (Group C). Both groups received titrated propofol sedation via Target-controlled infusion (TCI) with Schneider model until the Observer's Assessment of Alertness/Sedation (OAA/S) scale 0-1 was achieved. Hemodynamic variables, patient movement, postoperative pain score, patient and surgeon satisfaction score were recorded.
Overall, most patients (97.5%) had no to mild pain. Group F had significantly lower median NRS score at 30 minutes compared to Group C (0 [0, 0] vs. 0 [0, 0.25], p = 0.039). More patients in Group C experienced pain (90% vs. 75.8%, p = 0.038). Perioperative hypotension was higher in group F (81.7%) compared to Group C (61.3%) (p = 0.013). Thirty-five (56.5%) patients in Group F and 25 (42.7%) patients in Group C had movement during the procedure (p = 0.240). Surgeon's satisfaction score was higher in Group F (10 [9, 10]) than Group C (9 [9, 10]) (p = 0.037).
Combining low dose fentanyl with TCI propofol sedation may provide additional benefit on postoperative pain after TRUS-P biopsy, but results in perioperative hypotension. Fentanyl may attenuate patient movement during the procedure, which leads to greater surgeon's satisfaction.
经直肠超声引导前列腺（TRUS-P）活检在镇静下引起的术后疼痛通常较轻。镇静期间使用阿片类药物的益处存在争议。
本研究旨在比较单独使用丙泊酚或联合芬太尼镇静的患者在 TRUS-P 活检后 30 分钟时数字评分量表（NRS）评分。
我们将 124 例接受 TRUS-P 活检的患者随机分为芬太尼 0.5 mcg.kg 组（F 组）或生理盐水组（C 组）。两组均采用施奈德模型通过靶控输注（TCI）给予丙泊酚镇静，直至达到观察者警觉/镇静评分（OAA/S）0-1 级。记录血流动力学变量、患者运动、术后疼痛评分、患者和术者满意度评分。
总体而言，大多数患者（97.5%）的疼痛为无或轻度疼痛。F 组患者在 30 分钟时的 NRS 评分中位数显著低于 C 组（0 [0，0] 比 0 [0，0.25]，p = 0.039）。C 组更多的患者感到疼痛（90%比 75.8%，p = 0.038）。F 组术中低血压发生率高于 C 组（81.7%比 61.3%，p = 0.013）。F 组 35 例（56.5%）患者和 C 组 25 例（42.7%）患者在手术过程中出现运动（p = 0.240）。F 组术者满意度评分高于 C 组（10 [9，10] 比 9 [9，10]，p = 0.037）。
低剂量芬太尼联合 TCI 丙泊酚镇静可能在 TRUS-P 活检后提供额外的术后镇痛益处，但会导致围手术期低血压。芬太尼可能会减轻患者在手术过程中的运动，从而提高术者的满意度。
