Painkiller ‘whistle’ that can ease discomfort of a prostate biopsy
- The gas is inhaled through a handheld device commonly known as the ‘green whistle’
A pain-relieving gas that works within seconds is used to help men cope with the discomfort of prostate biopsies.
The gas, which contains a pain-relieving drug called methoxyflurane (brand name Penthrox), is inhaled through a handheld device commonly known as the “green whistle” because of its color and shape.
The portable device is designed to deliver strictly controlled amounts of the drug: enough to immediately relieve pain, but too little to cause side effects associated with taking large doses of the drug, such as kidney damage.
The ‘green whistle’ is an emergency pain-relieving treatment that has been widely used in Australia and New Zealand for almost half a century.
You can find it in emergency rooms, in ambulances and even in sports clubs, when someone needs fast-acting help. It has been available in Great Britain since 2014 and is mainly used by paramedics.
A pain-relieving gas that works within seconds is used to help men cope with the discomfort of prostate biopsies
The ‘green whistle’ is an emergency pain-relieving treatment that has been widely used in Australia and New Zealand for almost half a century (File image)
Now the Royal Surrey County Hospital in Guildford has become the first NHS center to offer the ‘green whistle’ to men undergoing biopsies for suspected prostate cancer.
Nearly 100,000 men a year in Britain have these to check for the presence of cancer cells.
This involves inserting an ultrasound probe into the rectum to produce an image of the prostate. Doctors then use this image to work out where to take tissue, before using a long needle to remove up to twelve small samples for examination.
The procedure is usually performed under local anesthesia to numb the area.
However, local anesthesia itself may cause some pain because the injection involves inserting the needle through the wall of the rectum to numb the area on either side of the prostate. In addition, the effectiveness of local anesthesia can vary from patient to patient; some are completely pain-free and others experience significant discomfort.
‘Sometimes the local anesthetic that is injected does not spread well,’ says Matthew Perry, a consultant surgeon and director of urology at the Royal Surrey County Hospital, who is leading the trial. This reduces the analgesic effect, he adds.
An estimated one in twenty men who require a prostate biopsy will require a general anaesthetic.
These may be cases where the tissue samples need to be taken from a less accessible area, which can prolong the procedure and increase discomfort. The hope is that the do-it-yourself relief – which allows men to administer it as needed throughout the procedure – will lead to fewer men needing a general anesthetic, as it will demonstrate their ability to control their own pain, thereby operating theaters become available and the NHS saves money.
About 40 men have used the green whistle at the hospital so far and initial results indicate very low pain scores when they inhale the gas, the hospital says. “The initial feedback has been very good, but we still need to work through the numbers,” Mr Perry said.
We try to make an invasive test as patient-friendly as possible. In addition to the pain relief, this gives men a degree of control. That is very important for them when they find themselves in a situation where many feel very vulnerable.’
Each green whistle device has enough Penthrox for about an hour. Although safe in these doses, the drug can make some patients dizzy.
Sophie Smith, senior specialist nurse at the charity Prostate Cancer UK, said the use of Penthrox is a ‘positive development’.
‘For some men, a biopsy can be a painful and anxiety-provoking procedure, so this will allow them to take greater control of their pain management.’
Did you know?
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“We understand their genetics, they are easy and relatively cheap to care for, and their basic biology is very similar to that of humans.”
However, mice are nocturnal animals. “This means that we collect results from mice when we are awake, but they are biologically ready to sleep,” he says in his book Life. These results are then ‘wrongly’ extrapolated to people.
In a recent study at Massachusetts General Hospital and Harvard Medical School, three drugs used to treat stroke in mice reduced brain tissue death when given during the day (when the mouse was biologically primed for sleep), but they failed when administered at night (when the mouse was biologically prepared for sleep). was awake).
These findings could explain why the treatments subsequently failed in human trials when they were given to humans at the same time as mice. ‘Biological time was very different,’ says Professor Foster. ‘Researchers must remember that timing really matters.’