Oral analgesia by non‐steroidal anti‐inflammatory drug zaltoprofen to manage cystoscopy‐related pain: A prospective study

Abstract

Objectives:To examine the pre-emptive analgesic effect of the non-steroidal anti-inflammatory drug zaltoprofen against rigid cystoscopy-associated pain, and compare it with the effect of an anesthetic gel. Methods: Forty men periodically undergoing follow-up office cystoscopy were enrolled in this prospective study. The effects of lidocaine gel alone or in combination with zaltoprofen, were examined. The following parameters were assessed using an 11-point numerical rating scale: pain during injection of gel into the urethra, insertion of rigid cystoscope, and the endoscopic examination of the urinary bladder, pain at the first urination after cystoscopy, and at the first urination in the following morning at home. Results: Pain scores with pre-emptive zaltoprofen plus lidocaine gel were significantly lower than the ones with lidocaine gel alone at the time points of inserting rigid cystoscope into the urethra, viewing inside the urinary bladder and the first urination after cystoscopy. The efficacy of zaltoprofen was more significant in the patients with higher baseline pain score. There was no correlation between pain scores and bladder cancer grading, number of tumors, and time from surgery. Conclusions: Pre-emptive zaltoprofen is able to control cystoscopy-associated pain, which translates into better quality of life for patients. Thus, its use is recommended in the management of these patients.Key words: non-steroidal anti-inflammatory drug, pain, pre-emptive analgesia, rigid cystoscopy, zaltoprofen. IntroductionCystoscopy is a useful but somewhat painful urological examination. Quite a few patients desire reduction of pain associated with cystoscopy.1 In the case of noninvasive urinary bladder cancer, which recurs in a large percentage of patients, 2-4 repeated recurrence may lead to the development of highly atypical infiltrating tumors. Therefore, prolonged follow-up by repeated cystoscopy is necessary, and the pain associated with this procedure needs to be minimized. In this regard , a flexible cystoscope was developed and is available in clinical practice. However, the use of rigid cystoscopes is still very common because it is less expensive, easier to handle and maintain and has a better visual field. Therefore, it is important to find a solution to reduce the pain associated with rigid cystoscopy.Lidocaine gel has proven effect against cystoscopyassociated pain [6][7][8] and is widely used; however, it does not provide adequate analgesic effect in some patients. Moreover, patients also complain of great pain during urination after cystoscopy. Therefore, even more effective methods are needed to reduce or prevent pain associated with cystoscopy. 1In this regards, analgesics that inhibit pain induced by bradykinin are expected to be effective, because bradykinin is involved in the nociceptive pain induced by cystoscopy. The non-steroidal anti-inflammatory drug (NSAID) zaltoprofen inhibits the generation of prostaglandins as well as the pain induced by bradykinin. [9][10][11][12] We conducted a prospe...

Is Diagnostic Cystoscopy Painful? Analysis of 1,320 Consecutive Procedures

“…Komiya et al (10) suggested that combining premedication oral zaltoprofen (a non-steroidal anti-inflammatory drug) with intraurethral lidocaine with improved the cystoscopy-associated pain and provided a better quality of life for the patients. Calleary et al (11) proposed that the addition of nitrous oxide inhalation for men younger than 55 years who were undergoing flexible cystoscopy.…”

Efficacy of preprocedural diclofenac in men undergoing double J stent removal under local anesthesia: A double-blind, randomized control trial

“…Lignocaine gel during this procedure has not been found to very effective. [12345] Zaltoprofen during check cystoscopy after transurethral resection (TUR) of bladder tumor (TURBT) has been proven to be more effective than lignocaine intraurethral analgesia. [5] Numerous reports exist on the effect of local anesthesia against cystoscopy-associated pain, but so far there has been no objective evaluation of the preemptive analgesic effect of nonsteroidal anti-inflammatory drugs (NSAIDs).…”

“…[12345] Zaltoprofen during check cystoscopy after transurethral resection (TUR) of bladder tumor (TURBT) has been proven to be more effective than lignocaine intraurethral analgesia. [5] Numerous reports exist on the effect of local anesthesia against cystoscopy-associated pain, but so far there has been no objective evaluation of the preemptive analgesic effect of nonsteroidal anti-inflammatory drugs (NSAIDs). [12] Hence, this study was undertaken to assess the effect of preemptive oral diclofenac in pain relief in patients undergoing DJ stent removal (DJSR) by rigid cystoscopy when compared to placebo and to assess the safety of oral diclofenac.…”

Preemptive Diclofenac in Men Undergoing Double J Stent Removal- A Randomized Double-Blinded Study

“…Lignocaine gel during this procedure is not very effective. [1], [2], [3], [4], [5] Numerous reports exist on the effect of local anesthesia against cystoscopy-associated pain, but so far there has been no study on the preemptive analgesic effect of nonsteroidal anti-inflammatory drugs (NSAIDs).…”