Electromotive drug administration of lidocaine to anesthetize the bladder before botulinum-A toxin injections into the detrusor

Abstract

Study design:Prospective, open label, cross-over-designed clinical study. Objective: To evaluate the effectiveness of an instillation of lidocaine into the bladder with versus without electromotive drug administration (EMDA) to anesthetize the bladder before botulinum-A toxin injections. Setting: Neurourology, Swiss Paraplegic Center, Balgrist University Hospital, Zurich, Switzerland. Methods: In all, 28 patients with severe neurogenic detrusor overactivity but preserved bladder sensibility were treated with botulinum-A toxin injections into the detrusor muscle. A measure of 300 u of botulinum-A toxin (Botox s ) was injected at 30 sites sparing the trigone. Prior to the injection, the bladder was anesthesized with conventional lidocaine instillation in a group of 10 patients and with lidocaine instillation enhanced by EMDA in 28 patients. The patients scored the injection pain on a 10-point rating scale. Pain rating scores with versus without EMDA enhancement of the lidocaine instillation were analyzed and the costs of the EMDA procedure were compared to general/spinal anesthesia. Results: The mean pain score of the 10 patients who underwent the injections of Botox s after conventional lidocaine instillation was 4.0 (SD 1.6). Following EMDA enhanced lidocaine instillation slight even or no pain occurred during the injections of Botox s , and the mean pain score was 0.5 (SD 0.2). Compared to spinal or general anesthesia, the local anesthesia saved around 15% of the costs. Conclusions: EMDA enhanced instillation of lidocaine enables a sufficient anesthesia of the bladder wall that ensures a painless application of the botulinum-A toxin injections into the detrusor muscle. This method may avoid general or spinal anesthesia in patients with preserved bladder sensibility. It ensures considerable cost reduction, avoids anesthesia-related risks and complications and enables the procedure on an outpatient basis.

A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance imaging

“…Local anaesthesia using electromotive drug administration of 2% lidocain was applied in patient 2 because of preserved bladder sensibility due to an incomplete spinal cord lesion (table 1) [21].…”

Advances in the Management of Neurogenic Detrusor Overactivity in Multiple Sclerosis

“…Botulinum toxin application into the istration on pain scores during subsequent botulinum toxin injections indicated that electromotive lidocaine administration was associated with a significant decrease in the pain score and ensured painless application of botulinum toxin in patients with preserved sensation. 33 This concept of electromotive drug administration was later applied to botulinum toxin to evaluate whether electromotively driven botulinum toxin application was effective in rabbits. 34 Compared with injections, electromotive lidocaine administration resulted in more uniform and homogeneous botulinum spread throughout the urothelium on immunohistologic staining.…”

New Frontiers in Intravesical Therapies and Drug Delivery

“…It has been reported that, compared to spinal or general anaesthesia, the local anaesthesia induced by lidocaine with EMDA saves around 15% of the costs [47]. This treatment modality allows clinicians to perform bladder distention also in an office setting, with equivalent results to distention under general anaesthesia and potentially less morbidity and lower costs [53,54].…”

“…Intravesical electromotive administration of both 5 and 15 mg oxybutynin significantly increased cystometric bladder capacity and significantly reduced the first volume for the onset of uninhibited detrusor contractions, and duration and maximum pressure of these contractions, in patients with neurogenic detrusor overactivity [29,30]. Clinical reports demonstrated that intravesical EMDA of local anaesthetics produced sufficient anaesthesia to allow transurethral resection of bladder tumours [45,46], to perform botulinum toxin A injections into the detrusor muscle [47], to administer intravesical capsaicin [48], and to determine cystodistention in the treatment of refractory interstitial cystitis and chronic noninfectious cystitis [49][50][51].…”