Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Urol. 2024 Feb;211(2):214-222. doi: 10.1097/JU.0000000000003789. Epub 2023 Nov 20.
Transrectal prostate biopsy is a common ambulatory procedure that can result in pain and anxiety for some men. Low-dose, adjustable nitrous oxide is increasingly being used to improve experience of care for patients undergoing painful procedures. This study seeks to evaluate the efficacy and safety of low-dose (<45%) nitrous oxide, which has not been previously established for transrectal prostate biopsies.
A single-institution, prospective, double-blind, randomized, controlled trial was conducted on patients undergoing transrectal prostate biopsies. Patients were randomized to receive either self-adjusted nitrous oxide or oxygen, in addition to routine periprostatic bupivacaine block. Nitrous oxide at levels between 20% and 45% were adjusted to patients' desired effect. Patients completed a visual analog scale for anxiety, State Trait Anxiety Inventory, and a visual analog scale for pain immediately before and after biopsy. The blinded operating urologist evaluated ease of procedure. Periprocedural vitals and complications were assessed. Patients were allowed to drive home independently.
A total of 133 patients received either nitrous oxide (66) or oxygen (67). There was no statistically significant difference in the primary anxiety end point of State Trait Anxiety Inventory or the visual analog scale for anxiety scores between the nitrous oxide and oxygen groups. However, patients in the nitrous oxide group reported significantly lower visual analog scale for pain scores compared to the oxygen group ( = .026). The operating urologists' rating of tolerance of the procedure was better in the nitrous oxide group ( = .03). There were no differences in biopsy performance time. Complications were similarly low between the 2 groups.
Patient-adjusted nitrous oxide at levels of 20% to 45% is a safe adjunct during transrectal prostate biopsy. Although there was not an observed difference in the primary end point of anxiety, nitrous oxide was associated with lower patient-reported pain scores.
经直肠前列腺活检是一种常见的门诊程序，可能会给一些男性带来疼痛和焦虑。越来越多的低剂量、可调节的一氧化二氮被用于改善接受疼痛程序的患者的护理体验。本研究旨在评估低剂量（<45%）一氧化二氮的疗效和安全性，此前尚未将其用于经直肠前列腺活检。
在进行经直肠前列腺活检的患者中进行了一项单机构、前瞻性、双盲、随机、对照试验。患者随机接受自我调节的一氧化二氮或氧气，以及常规的前列腺周围布比卡因阻滞。一氧化二氮的浓度在 20%到 45%之间，根据患者的预期效果进行调节。患者在活检前后立即使用视觉模拟量表评估焦虑、状态特质焦虑量表和疼痛视觉模拟量表。盲法操作泌尿科医生评估手术的难易程度。评估围手术期生命体征和并发症。患者可以自行独立开车回家。
共有 133 名患者接受了一氧化二氮（66 名）或氧气（67 名）治疗。在状态特质焦虑量表或焦虑视觉模拟量表的主要焦虑终点方面，一氧化二氮组和氧气组之间没有统计学上的显著差异。然而，与氧气组相比，一氧化二氮组的疼痛视觉模拟量表评分明显较低（=.026）。一氧化二氮组的操作泌尿科医生对手术耐受性的评分更好（=.03）。活检性能时间无差异。两组并发症发生率相似。
20%至 45%的患者调节的一氧化二氮是经直肠前列腺活检的一种安全辅助手段。尽管在焦虑的主要终点方面没有观察到差异，但一氧化二氮与较低的患者报告疼痛评分相关。
