Practical Use of Self-Adjusted Nitrous Oxide During Transrectal Prostate Biopsy: A Double-Blind Randomized Controlled...

Area of Science:

• Urology
• Anesthesiology
• Pain Management

Background:

• Transrectal prostate biopsy is a common procedure associated with patient pain and anxiety.
• Low-dose, adjustable nitrous oxide (N2O) is used for painful procedures, but its efficacy for prostate biopsies is not well-established.

Purpose of the Study:

• To evaluate the efficacy and safety of low-dose (<45%) patient-adjusted nitrous oxide (N2O) for transrectal prostate biopsies.
• To assess the impact of N2O on patient anxiety and pain during the procedure.

Main Methods:

• A prospective, double-blind, randomized controlled trial involving 133 patients undergoing transrectal prostate biopsy.
• Patients received either self-adjusted nitrous oxide (20-45%) or oxygen, alongside a bupivacaine block.
• Anxiety and pain were measured using validated scales; procedural ease and complications were also assessed.

Main Results:

• No significant difference in anxiety scores (State Trait Anxiety Inventory, visual analog scale) between nitrous oxide and oxygen groups.
• Patients receiving nitrous oxide reported significantly lower pain scores (visual analog scale) (P = .026).
• Operating urologists rated procedural tolerance higher in the nitrous oxide group (P = .03); complication rates were similar.

Conclusions:

• Patient-adjusted nitrous oxide (20-45%) is a safe adjunct for transrectal prostate biopsies.
• Nitrous oxide effectively reduces patient-reported pain and improves procedural tolerance, despite not significantly impacting anxiety levels.