- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02935972
Combined Intravenous Diazepam, Local Periprostatic Nerve Block for Prostate Biopsy
Pain Reduction During Transrectal Ultrasound-guided Biopsy of the Prostate: Intravenous Diazepam, Local Periprostatic Nerve Block or Combination
Prostate biopsy under transrectal ultrasound (TRUS) guidance is considered the procedure of choice for diagnosing prostate cancer. And as in any other diagnostic biopsy procedures; patients perceive anxiety before, during and after biopsy and ultrasound guided prostate biopsy is not an exclusion.
TRUS guided prostatic biopsies are mainly performed in an outpatient clinic, men undergoing transrectal prostate biopsy experience considerable psychological stress. It may be attributable to the fear of the potential diagnosis of cancer, the anal route of penetration, the fact that the subject organ examined is part of the sexual system and the anticipated pain and as a matter of fact the issues of discomfort and pain perceived throughout the procedure referred to the negative impact of the whole procedure, that is probe insertion and biopsy punctures.
Thus it is essential to employ a simple method that can liberate the patient from pain during prostate biopsy. Some studies recommend sedation , others recommend intra-rectal lidocaine gel and others periprostatic nerve block while others recommend Nitrous oxide inhalation as an effective method of analgesia for the procedural related pain or discomfort of prostate biopsy. The employment of analgesics, sedation and/or narcotic medication may alleviate much of the discomfort associated with transrectal prostate biopsy, such treatment may be associated with additional risks. Furthermore, when systemic medication is administered, patients require conscious sedation monitoring during and after the procedure, which may be inconvenient and relatively expensive in addition to their unsuitability to be performed on outpatient clinic basis. Therefore, a simple form of anesthesia is desirable.
Although a wide variety of anesthetic techniques are available for transrectal ultrasound-guided prostate biopsy, including rectal administration of lidocaine gel, periprostatic nerve blocks, intravenous propofol, and narcotic intramuscular premedication, these methods may not optimally prevent or relieve pain.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
From November 2013 to November 2014, 336 patients fitted our inclusion criteria underwent transrectal ultrasound-guided prostate biopsy (TRUSPB).
Informed consent was obtained from all patients after detail description of the study.
Bowel preparation with cleansing enema (a sodium phosphate and dibasic sodium phosphate enema) and antibiotic prophylaxis with Levofloxacin 500 mg. was prescribed.
Patients were randomized into three equal groups where Group I: to receive intravenous diazepam 5 mg slowly just before probe insertion Group II: received 10 cc of 1% Lidocaine injected into the periprostatic nerve plexus bilaterally under ultrasound guidance using a 22 gauge 7 inch needle , prior to injection caution was taken to aspirate before injection to avoid accidental intravascular injection of lidocaine, proper needle placement and injection of lidocaine a sonographic hypoechogenicity is created between the rectal wall and the base of the seminal vesicles causing the seminal vesicles to separate from the rectal wall and appear to be raised (fig.1) prostate biopsies had begun 2 to 3 minutes after lidocaine injection. Group III: intravenous diazepam 5 mg slowly just before probe insertion and 10 cc of 1% Lidocaine injected into the periprostatic nerve plexus bilaterally under ultrasound guidance.
Prostatic biopsies was performed in combined directed and random technique or extended random technique in absence of focal abnormality with mean number of biopsies 10 biopsies (9 to 12 biopsy) were done per patient.
The sedation scale were evaluated according to sedation scale. After the procedure, discomfort and pain experienced during performing the biopsy technique were graded using a 10-point linear visual analog pain scale.
All patients were monitored during and after the procedure for possible complications, patients were also questioned regarding any adverse effect at one week duration (at the time of receiving the histopathological results).
Study Type
Enrollment (Actual)
Phase
- Phase 2
- Phase 3
Contacts and Locations
Study Locations
-
-
-
Assiut, Egypt, 71515
- Assiut University Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- abnormal digital rectal examination
- elevated PSA
- focal abnormality in TRUS.
Exclusion Criteria:
- previous allergy to diazepam or lidocaine
- bleeding diathesis or anticoagulant therapy
- history of chronic prostatitis
- acute anal and rectal conditions (as haemorrhoids, anal fissures or strictures)
- neurological conditions
- patients with respiratory asthma or chronic liver diseases
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Diazepam
received intravenous diazepam 5 mg slowly just before TRUS probe insertion
|
received intravenous diazepam 5 mg slowly just before TRUS probe insertion
|
Active Comparator: Local
received 10 cc of 1% Lidocaine injected into the periprostatic nerve plexus bilaterally under ultrasound guidance
|
received 10 cc of 1% Lidocaine injected into the periprostatic nerve plexus bilaterally under ultrasound guidance
|
Active Comparator: Combined
received intravenous diazepam 5 mg slowly just before TRUS probe insertion and 10 cc of 1% Lidocaine injected into the periprostatic nerve plexus bilaterally under ultrasound guidance
|
received intravenous diazepam 5 mg slowly just before probe insertion and 10 cc of 1% Lidocaine injected into the periprostatic nerve plexus bilaterally under ultrasound guidance
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Visual Analogue Score
Time Frame: 2 hours
|
degree of pain during prostate biopsy
|
2 hours
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Sedation Score
Time Frame: 2 hours
|
degree of sedation during prostate biopsy
|
2 hours
|
Complications
Time Frame: 2 hours
|
hematuria, haematochezia or infection were recorded
|
2 hours
|
Collaborators and Investigators
Sponsor
Investigators
- Study Director: HAMDY A. YOUSSEF, MD, Assiut University
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Anti-Arrhythmia Agents
- Central Nervous System Depressants
- Autonomic Agents
- Peripheral Nervous System Agents
- Sensory System Agents
- Anesthetics, Intravenous
- Anesthetics, General
- Anesthetics
- Antiemetics
- Gastrointestinal Agents
- Tranquilizing Agents
- Psychotropic Drugs
- Membrane Transport Modulators
- Hypnotics and Sedatives
- Adjuvants, Anesthesia
- Anti-Anxiety Agents
- GABA Modulators
- GABA Agents
- Anticonvulsants
- Anesthetics, Local
- Voltage-Gated Sodium Channel Blockers
- Sodium Channel Blockers
- Neuromuscular Agents
- Muscle Relaxants, Central
- Lidocaine
- Diazepam
Other Study ID Numbers
- Diazepam and TRUS Biopsy
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Pain Relief During Prostate Biopsy
-
University Hospital, GhentCompletedPain Relief During LabourBelgium
-
Gangnam Severance HospitalUnknownTransrectal Systematic Prostate Biopsy Related PainKorea, Republic of
-
Mayo ClinicClear Guide Medical Inc.Enrolling by invitation
-
Royal Marsden NHS Foundation TrustUnknown
-
Modarres HospitalCompleted
-
The University of Texas Health Science Center at...CompletedProstate Biopsy | Antibiotic TherapyUnited States
-
Wake Forest University Health SciencesCompleted
-
IRCCS Burlo GarofoloCompleted
-
Rijnstate HospitalWithdrawn
-
Western Galilee Hospital-NahariyaWithdrawn
Clinical Trials on Diazepam
-
University of MonastirNot yet recruiting
-
Eisai Inc.CompletedLymphoma, B-CellUnited States
-
Jason GilleranTerminatedMetabolism, DrugUnited States
-
University of CincinnatiCompleted
-
University of PittsburghNational Institute on Drug Abuse (NIDA)Completed
-
Acorda TherapeuticsCompleted
-
Acorda TherapeuticsTerminatedRefractory EpilepsyUnited States
-
Aquestive TherapeuticsSyneos Health; CovanceCompletedEpilepsyUnited States
-
Mayo ClinicCompletedMyocardial Reperfusion InjuryUnited States
-
Institute of Mental Health, SingaporeSingapore Clinical Research InstituteCompletedOpiate Dependent Patients Who Are Undergoing Inpatient Detoxification in SingaporeSingapore