Journal Article

A 50-50% mixture of nitrous oxide-oxygen in transrectal ultrasound-guided prostate biopsy: A randomized and prospective clinical trial

Barrucand, Louis, Verçosa, Nubia, Cazarim, Gabriel da Silva, Pastor, Rachel, da Silva, Elizabeth Fernandes Vaz, Carneiro, Leonel, Cavalcanti, Ismar Lima

2018

Overview

Transrectal ultrasound-guided biopsy (TUSPB) is the standard method of diagnosis for prostate cancer, and although it is well tolerated by some patients, it presents a discomfort rate of 65 to 90%, which may be associated with pain. For convenience, it is agreed that a method of analgesia and sedation is necessary. For this purpose, this study aimed to evaluate the impact of inhalation of a 50-50% N2O-O2 gas mixture on pain intensity in these patients. Randomized, double-blinded clinical trial, conducted at Antônio Pedro University Hospital (Hospital Universitário Antônio Pedro), Niterói, RJ, Brazil, containing two groups of 42 patients: a control (C) group, which received 100% oxygen inhalation, and a nitrous oxide (NO) group, which received inhalation of the 50-50% N2O-O2 mixture, self-administered during TUSPB. The pain intensity and degree of satisfaction were evaluated through a visual analogue scale (VAS), as was the frequency of adverse events. Eighty-four patients were included in the study, with 42 in each group. The mean pain intensity was lower in the NO group than in the C group [2.52 (0-10) vs 5.95 (0-10), p < 0.001], and the degree of satisfaction was higher in the NO group than in the C group (8.14 vs. 4.69, p < 0.001). The adverse effects were somnolence, dizziness, nausea, vomiting, discomfort and euphoria without differences between the groups. The 50-50% N2O-O2 mixture was effective in reducing pain intensity and increasing the degree of satisfaction in TUSPB, with tolerable side effects.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Administration, Inhalation / Aged / Aged, 80 and over / Analgesia / Analgesics / Analgesics, Non-Narcotic - adverse effects / Analgesics, Non-Narcotic - therapeutic use / Anesthesia / Anesthesiology / Biology and Life Sciences / Biopsy / Blood pressure / Care and treatment / Clinical trials / Colonoscopy / Complications and side effects / Diagnosis / Discomfort / Dosage and administration / Double-Blind Method / Gases - adverse effects / Gases - therapeutic use / Humans / Image-Guided Biopsy / Inhalation / Male / Medicine and Health Sciences / Methods / Middle Aged / Nausea / Nitrous oxide / Nitrous Oxide - adverse effects / Nitrous Oxide - therapeutic use / Oxygen / Oxygen - adverse effects / Oxygen - therapeutic use / Pain / Pain Measurement / Pain perception / Pain, Procedural - drug therapy / Patient Satisfaction / Patients / People and places / Physical Sciences / Prostate - diagnostic imaging / Prostate - pathology / Prostate - surgery / Prostate biopsy / Prostate cancer / Randomization / Rectum - diagnostic imaging / Rectum - surgery / Research and Analysis Methods / Respiration / Side effects / Treatment Outcome / Ultrasonic imaging / Ultrasonography, Interventional / Ultrasound / Urology / Vomiting