Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.02.001
Brazilian Journal of Anesthesiology
Clinical Research

Propofol with or without fentanyl for pain relief after transrectal ultrasound-guided prostate (TRUS-P) biopsy: a randomized controlled study

Propofol com ou sem fentanil para alívio da dor após biópsia transretal da próstata guiada por ultrassom (TRUS-P): um estudo randomizado controlado

Sirilak Suksompong, Panop Limratana, Niruji Saengsomsuan, Nattaporn Wongsawang, Nophanan Chaikittisilpa

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Abstract

Background
Postoperative pain from transrectal ultrasound-guided prostate (TRUS-P) biopsy under sedation is often mild. Benefit of opioids used during sedation is controversial.

Objective
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.

Methods
We randomly allocated 124 patients undergoing TRUS-P biopsy to receive either fentanyl 0.5 mcg. kg-1 (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.

Results
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).

Conclusion
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.

Keywords

Postoperative pain;  Cancer of prostate;  Deep sedation;  Propofol;  Fentanyl

Resumo

Introdução: A dor pós-operatória da biópsia transretal da próstata guiada por ultrassom (TRUS-P) sob sedação costuma ser leve. O benefício dos opioides usados durante a sedação é controverso. Objetivo: O objetivo foi comparar a pontuação da escala de classificação numérica (NRS) 30 minutos após a biópsia TRUS-P entre pacientes que receberam propofol sozinho ou com fentanil. Métodos: Alocamos aleatoriamente 124 pacientes submetidos à biópsia TRUS-P para receber fentanil 0,5 mcg / kg-1 (Grupo F) ou solução salina normal (Grupo C). Ambos os grupos receberam sedação titulada de propofol via infusão controlada pelo alvo (TCI) com modelo de Schneider até que a escala 0-1 da Avaliação de Alerta / Sedação do Observador (OAA / S) fosse alcançada. Variáveis hemodinâmicas, movimento do paciente, escore de dor pós-operatória, escore de satisfação do paciente e do cirurgião foram registrados. Resultados: No geral, a maioria dos pacientes (97,5%) apresentou dor de não a leve. Grupo F teve pontuação NRS mediana significativamente menor em 30 minutos em comparação com o Grupo C (0 [0, 0] vs. 0 [0, 0,25], p = 0,039). Mais pacientes no Grupo C sentiram dor (90% vs. 75,8%, p = 0,038). A hipotensão perioperatória foi maior no grupo F (81,7%) em relação ao grupo C (61,3%) (p = 0,013). Trinta e cinco (56,5%) pacientes do Grupo F e 25 (42,7%) pacientes do Grupo C apresentaram movimentação durante o procedimento (p = 0,240). O escore de satisfação do cirurgião foi maior no Grupo F (10 [9, 10]) do que no Grupo C (9 [9, 10]) (p = 0,037). Conclusão: A combinação de fentanil em baixas doses com sedação com TCI propofol pode fornecer benefício adicional na dor pós-operatória após biópsia TRUS-P, mas resulta em hipotensão perioperatória. O fentanil pode atenuar o movimento do paciente durante o procedimento, o que leva a uma maior satisfação do cirurgião.

Palavras-chave

Dor pós-operatória; Câncer de próstata; Sedação profunda; Propofol; Fentanil.

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