The ‘green whistle’: A novel method of analgesia for transrectal prostate biopsy
Version of Record online: 29 NOV 2012
© 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL
Special Issue: BJU International Australia and New Zealand Supplement
Volume 110, Issue Supplement S4, pages 85–88, December 2012
How to Cite
Grummet, J., Huang, S., Konstantatos, A. and Frydenberg, M. (2012), The ‘green whistle’: A novel method of analgesia for transrectal prostate biopsy. BJU International, 110: 85–88. doi: 10.1111/j.1464-410X.2012.11613.x
- Issue online: 29 NOV 2012
- Version of Record online: 29 NOV 2012
- Manuscript Accepted: 24 AUG 2012
- needle biopsy;
What's known on the subject? and What does the study add?
Periprostatic infiltration of local anaesthetic (PILA) is accepted as the current ‘gold standard’ of analgesia for TRUS-guided biopsy. However, it does not account for discomfort of anal probe insertion and has not received wide uptake amongst clinicians. A better method is therefore sought. PenthroxTM (methoxyflurane) is an effective systemic analgesic that is self-administered via a hand-held inhaler. Its use in TRUS-guided biopsy has not been previously reported.
An initial experience with a novel analgesic for TRUS-guided biopsy, which appears to be safe and effective. It has led to the planning of a randomised control trial, which will compare Penthrox with PILA for TRUS-guided biopsy.
- To determine the feasibility of using a novel inhaled analgesic agent (PenthroxTM, methoxyflurane)) for transrectal ultrasonography (TRUS)-guided biopsies of the prostate.
Patients and methods
- Patients undergoing TRUS-guided biopsies were each given a Penthrox inhaler to self-administer during the procedure and instructed in its use.
- Immediately after the procedure, patients were asked to rate their pain using a verbal rating scale from 0 to 10.
- In all, 42 consecutive men underwent a TRUS-guided biopsy.
- The median pain score was 3.
- All 42 patients stated they would be happy to undergo the same procedure again. The only adverse effects reported by patients were brief light-headedness and a sickly sweet taste.
- This study of our initial experience using Penthrox suggests that it may have a role in analgesia for TRUS-guided biopsy.
- It may provide safe, adequate analgesia that is easy for urologists to use and avoids excessive use of resources.
- Planning for a randomised control trial comparing Penthrox to the current ‘gold standard’ of prostatic infiltration of local anaesthetic is presently underway.