A Controlled Study of Low and High Volume Anesthetic Jelly as a Lubricant and Pain Reliever During Cystoscopy

Abstract

To evaluate the influence of the volume of 2% lidocaine jelly as an anesthetic during cystoscopy 241 men and women received either 11 or 20 ml. jelly intraurethrally in a randomized, double-blind fashion. Pain was recorded on a visual analogue scale by the patient and on a 3-level scale by the physician. The pain scores according to the visual analogue scale were significantly higher in the patients given 11 ml. jelly than in those given 20 ml. when all patients in the study were analyzed. There was no significant difference in the visual analogue scale between the 2 treatments in women but a significant difference was noted in men, although in men older than 55 years the difference was not statistically significant. There was general agreement between the visual analogue scale results and the physician scores but the visual analogue scale procedure was more sensitive in detecting differences between treatments. It is suggested that approximately 11 ml. 2% lidocaine jelly is the appropriate volume for women and 20 ml. is the appropriate volume for men during cystoscopy but that the lower volume of jelly may be sufficient in older men.

Intraurethral Lubricants: A Critical Literature Review and Recommendations

“…The value of adequate volume during rigid cystoscopy was outlined by Goldfisher and associates 29 and confirmed by Brekkan and coworkers 30 and Holmes and colleagues. 36 They found that a minimal volume of 20 mL is necessary to increase anesthetic efficacy.…”

“…30 They evaluated the influence of instilled volume (11 vs 20 mL) in pain perception and found a significant pain reduction in the group of male patients with the use of 20 mL of the anesthetic lubricant. No difference was found among the two groups of women [Ib, A].…”

“…Chen and colleagues 35 reported that lidocaine gel is more than three times more expensive than plain gel in Taiwan. Patel and coworkers 30 reported that the cost of 10 mL of lidocaine gel, which is $4.64 vs $0.86 for 4 ounces of plain gel at their institution, is not reimbursed and must be borne by the urology practice.…”

Effect of Intraurethral Dwell Time of Local Anesthetic Jelly on Pain Perception in Men Undergoing Outpatient Rigid Cystoscopy: A Randomized Prospective Study

“…1,5,9 Slow instillation was chosen for this study as it has been reported that a slow rate of jelly instillation is associated with less pain. 6 In our study, patients in group A (5 minutes intraurethral dwell time) and B (10 minutes intraurethral dwell time) experienced significantly more pain as compared to patients in group C (15 minutes intraurethral Jelly was instilled 5, 10, 15, and 20 minutes before start of the procedure in Group A, B, C, and D patients, respectively.…”

“…[2][3][4] For men, 20 mL of 2% lidocaine jelly instilled slowly before start of the rigid cystoscopy procedure is considered optimum for maximum pain relief. 5,6 However, the optimal intraurethral dwell time of the anesthetic jelly for maximal pain relief, that is, ''how long a urologist should wait after anesthetic jelly instillation before starting the procedure'' is not known with only a few studies addressing this issue. 1,7 In this prospective, randomized study, we look at varying dwell times in an attempt to define the ''optimum dwell time'' for maximal pain relief.…”