Anesthesia during Prostate Biopsy - Have you been fully anesthetized during the Procedure, or not?

I had it done at my Urologists office and was awake the whole time. I felt every needle prick and had to clean up a very bloody mess.
So, it sucked.
Maybe they could have waited longer for the numbing shot to take, maybe they could have informed me that I was going to be that bloody and that it was my responsibility.
But they didn't, so I stand with, it sucked.

Ace, I had IV anesthesia like what you have with a colonoscopy. Took a nice nap. My urologist believed in a pain free experience and that's what it was.

Jim

I was given a bullet to bite on...

Will this be done in the office or in an OR? That could make a big difference in how much they give you.

I was offered a general anesthesia if desired, but went with just numbing in the office. He did a very good local comparable to what a good dentist does, IOW only mild discomfort for the injection. After that, I essentially felt nothing although each "snap" of the spring loaded biopsy device could wear on a man's nerves for sure. It sounds like it should hurt. But I felt no pain.

With conscious sedation, it basically just calms your nerves and depending on what they give it might give you amnesia for the event. But in an office setting, they are probably not going to give you much if any, because:
1: they sure don't want to have to resuscitate you if the give you a little too much
2: you are probably not NPO(empty stomach) and for that reason they sure don't want you going all the way out by accident
3: If they gave you much at all, they would have to make sure some one came with you to drive you home. etc etc.

Since I had nothing but local and did just fine with no significant pain, I know that conscious sedation would have been more than enough for me. Sure, I was anxious and it was no fun and a bloody mess as was already said, but no real pain. But if nerves or just the thought of all of that really gets to you, then conscious sedation would be called for. And no way I can guarantee that your URO can give as good of a local block as mine did. If a flat out nervous wreck and terrified of the procedure, ask for a general and be done with it.

BUT, you are also having a cystoscopy? That could require more. Again, is this in office? If so, is any anesthesia personnel involved? If they are, don't worry about it. See if you can find this out, and while you are at it find out what they give, and if any propofol will be involved. If so, then as far as you will know, it will seem just like a general. For that matter, if they even just give you at least 2 mg of Versed, I doubt you will remember anything about it afterwards.

Post Edited (BillyBob@388) : 2/18/2016 10:54:00 AM (GMT-7)

Billybob@388: Great input, and I must have just missed your incoming reply as my last message was being prepared. Yes, it looks like your input is 100% on the money. It is going to be done in a Day Surgery OR, and it sounds like they will be administering the kinds of pain medications in the conscious sedation that you reference. Thanks for the detailed input, and for taking the time to share your experience and wise counsel.

Ace- I was sedated but not put under. Overall it was not a pleasant experience, but not horrific either. Pain (more like discomfort) level on a 1-10, I'd say about a 5. By about the 10th or 11th sample I was ready for it to be done. If you can imagine a rubberband being snapped against your cheek.... thats kind of what it feels like. The actual procedure took only about 10 minutes. Be prepared for the brown blood in your semen for about a month after. Its perfectly harmless and normal.

Also, I had mine done at 11am, thinking I would go back to work in the afternoon. Uh, no. I was done for the day.

ARIS,

Glad to meet you, sorry you have to be here though.

I've had both standard biopsies and the MRI fusion biopsy done myself. I've had no numbing, my first biopsy way back in year 2000, that sucked, no two ways about it. I had a saturation biopsy back in 2005 under conscious sedation with IV similar to a colonoscopy and remember nothing and felt nothing during the procedure. I had a numbed biopsy guided by MRI results in 2013 with local lidocaine injections. The lidocaine injections - three of them if memory serves - were uncomfortable but the remainder of the 14 core biopsies were hardly felt at all.

I then had a MRI fusion biopsy at the NIH in May 2015, again with local numbing using lidocaine injections. For some reason, this time around, I felt the core shots, and winced a few times from the pain, and with the fusion biopsy - you have to be perfectly still otherwise they have to recalibrate the software that aligns the MRI and TRUS imaging when you move. So, I would definitely recommend conscious sedation for the MRI fusion biopsy process based upon my experience. Hope this helps!

No anesthesia. Took 3 xanax, .5 mg each. Took one before i left the house, one on the way, and one when i got to the Drs office.
Honesty i didnt need al lthat .But it was fun.

Oh, i did get a lidocaine injection in my Prostate before he started

Mine was in the urologists office. I had an antibiotic shot in the rear. A numbing shot and the ultrasound tube inserted. Heard and felt the 14 snaps but was not painful. The blood in urine and clots afterward were the worst. All in all it was not too bad.

Good luck

Carl

I've had 3 biopsies. The first was done without anything other than local numbing. The pain got to be too much, and I had a vasovagal reflex shock that tanked my BP. The next was done under general anaesthesia, which left me dopey for a couple of days. The third one was the Goldilocks one - they used a "periprostatic nerve block" after local numbing. No pain, no hangover. I was fully alert throughout and was able to drive home.

I read about a new procedure called a "pelvic plexus block" that may be superior.
Transrectal ultrasonography (TRUS)-guided pelvic plexus block to reduce pain during prostate biopsy: a randomised controlled trial

With nerve blocks, you need a doctor who knows how to locate those nerves on an ultrasound - so you have to ask your urologist if there's someone who can do this.

The other thing we have to be increasingly vigilant about is increasing rates of antibiotic-resistant infection. You should tell your urologist which antibiotics you've had previous exposure to. A rectal swab and culture is prudent but could delay your procedure. Some have found that applying a povidone-iodine gel to the area may reduce infection.

sheepguy said...
... I felt nothing except the initial insertion of the US probe which was kind of like a bad day at Joliet prison for a second.

Thats HILARIOUS!

Tall Allen said...
......we have to be increasingly vigilant about is increasing rates of antibiotic-resistant infection. You should tell your urologist which antibiotics you've had previous exposure to. A rectal swab and culture is prudent but could delay your procedure. Some have found that applying a povidone-iodine gel to the area may reduce infection.

I think the need for this tends to be underestimated in many cases.

Some people are cipro resistant and an infection _can_ become serious. If IIRC on this forum I saw a post about an individual who went into a life threatening sepsis situation.

I would say if at all possible go ahead with the rectal swab.

FWIW, the Dr at Duke told me that since he began a new protocol that including a rectal swab pre-biopsy that he had zero infections. I do not know what else if anything the protocol included.