Randomized controlled trial of belladonna and opiate suppository during intravesical onabotulinum toxin A injection

LeClaire, Edgar L.; Duong, Jennifer; Wykes, Rachel M.; Miller, Kevin E.; Winterton, Tessa; Bimali, Milan

doi:10.1016/j.ajog.2018.06.004

Cited by 5 publications

(6 citation statements)

References 14 publications

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“…This review identified three studies that identified that reducing the number of injections reduced pain scores. 20,21,26 The sample size was however small for all three studies (range [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. Two of these studies also assessed whether fewer injections were associated with a reduction in effectiveness.…”

Section: Risk Of Biasmentioning

confidence: 99%

Interventions to improve tolerability of local anesthetic intradetrusor Botulinum toxin injections: A systematic review

Walker

Macpherson

Tasleem

et al. 2022

Neurourology and Urodynamics

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Introduction Intradetrusor BotulinumtoxinA (BTA) injections are recommended for patients with overactive bladder (OAB) refractory to lifestyle changes and medical intervention. It is preferable to perform injections using a flexible cystoscope under local anesthetic (LA) rather than under spinal or general anesthetic owing to the associated anesthetic risks, increased costs, and need for repeated inpatient admission. Injections under LA can be difficult to tolerate for some patients. This review aims to assess interventions that may improve the tolerability of intradetrusor BTA injections under LA. Methods A systematic review was performed using Ovid of Embase + Embase classic and MEDLINE® ALL in November 2021. Articles were included if they reported objectively measured pain scores during LA intradetrusor BTA injections for refractory OAB. The risk of bias was assessed using Cochrane risk of bias tools. Meta‐analysis was not performed owing to the heterogeneity of outcome measures. Results Ten studies were included in this review with a total of 429 participants. The review identified alkalinized lidocaine, electromotive drug administration (EMDA), opiate suppositories, lidocaine bladder instillations, number of injections, and dose of BTA as interventions aimed at improving tolerability. Conclusion EMDA of intravesical alkalinized lidocaine, intravesical, alkalinized lidocaine without EMDA, and a reduction in the number of injection site were all associated with improvements in patient tolerability during LA BTA injections. Further research should address which subgroups of patients find the procedure most painful and would benefit most from these interventions.

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Section: Risk Of Biasmentioning

confidence: 99%

Interventions to improve tolerability of local anesthetic intradetrusor Botulinum toxin injections: A systematic review

Walker

Macpherson

Tasleem

et al. 2022

Neurourology and Urodynamics

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“…E.L. LeClaire и соавт. опубликовали данные проспективного исследования эффективности и безопасности местного обезболивания: внутрипузырной инстилляции 2% раствора лидокаина и суппозитория белладонны с морфином 16,2/7,5 мг в сравнении с суппозиториемплацебо у пациентов 18 лет и старше с рефрактерными симптомами нижних отделов мочеполового тракта, перенёсших инъекцию БТА в детрузор [18]. Это первое исследование, в котором изучена прогрессия и регрессия боли, о которой сообщают пациенты, во время внутрипузырного введения БТА.…”

Section: Abstract: Pandemic Covid-19; Urodynamic Studies; Botulinum T...unclassified

“…Ни в одной из групп не увеличился риск задержки мочеиспускания в краткосрочной перспективе. Суппозитории белладонны и опиатов не имели выраженного обезболивающего эффекта по сравнению с группой плацебо [18].…”

Section: Abstract: Pandemic Covid-19; Urodynamic Studies; Botulinum T...unclassified

Urodynamic studies and features of anaesthesia during intradetrusor botulinum therapy in the context of the COVID-19 pandemic (literature review)

Lysachev

Ходырева

Stroganov

et al. 2021

Zdravoohran. Ross. Fed.

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The coronavirus pandemic has had a severe impact on the health care system. It is also changing the appointment and conduct of diagnostic procedures, emergency and routine medical care. According to the medical guidelines of the European Society of Urology (EAU) for the provision of urological care during the current epidemic situation, various levels of urgency have been proposed for diagnostic and therapeutic measures depending on the type of disease. Urodynamic studies refer to studies with a priority level from P2 (for neurogenic dysfunction of the urinary tract) to P4 (for lower urinary tract dysfunction without the risk of damage to the upper urinary tract). The question arises regarding the safety of these studies, both for patients and medical staff, and possible measures to reduce the risk of infection in a viral pandemic. Because of the increased workload of hospitals that have not been redesigned for the fight against coronavirus infection and provide routine and emergency urological care, an even greater need has arisen to find effective and safe methods of local anaesthesia for performing urodynamic studies and intradetrusive injections of botulinum toxin type A under local anesthesia in outpatient and outpatient settings (for example, in a short-term hospital). This article presents a literature review on the principles and features of performing urodynamic studies in the context of the Covid-19 pandemic and the effectiveness and safety of using various methods of local anaesthesia when performing intradetrusor injections of botulinum toxin with detrusor hyperactivity of a neurogenic and non-neurogenic nature. There were evaluated forms of local anaesthesia such as intradetrusor instillation of lidocaine, electrophoresis, and the use of alternative solutions for urinary bladder irrigation (for example, Ringer’s solution).

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“…For the latter, the anesthetic protocols vary between departments and lack standardization—both lidocaine and other drugs have been used in different concentrations, volume instilled, and formulations (liquid, gel or a combination of both) 2–4 . A recent study regarding pain during BoNTA injection tried the administration of opioid and belladonna suppository during the procedure, with nonsignificant results 5 . BoNTA delivery without injection is also being researched, using a carrier, hyaluronan–phosphatidylethanolamine, to translocate BoNTA across the urothelium, with only experimental, yet promising results 6 …”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4] A recent study regarding pain during BoNTA injection tried the administration of opioid and belladonna suppository during the procedure, with nonsignificant results. 5 BoNTA delivery without injection is also being researched, using a carrier, hyaluronan-phosphatidylethanolamine, to translocate BoNTA across the urothelium, with only experimental, yet promising results. 6 Lidocaine is the most used anesthetic in this setting.…”

Section: Introductionmentioning

confidence: 99%

Alkalinized lidocaine solution as a first‐line local anesthesia protocol for intradetrusor injection of onabotulinum toxin A: Results from a double‐blinded randomized controlled trial

Silva

Ponte

Lopes

et al. 2020

Neurourology and Urodynamics

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Aims: Local anesthesia protocols for intradetrusor onabotulinum toxin A (BoNTA) injection lack standardization. We aimed to determine if an alkalinized lidocaine solution is more effective than lidocaine only. Methods: Patients of both genders aged 18 or above enlisted for intradetrusor BoNTA injection (idiopathic, neurogenic, and bladder pain syndrome) were included in a double-blinded randomized controlled trial after obtaining their informed consent. All participants filled a bladder diary and a urine culture was performed. Subjects were randomized 1:1 to Protocol A (20 ml 2% lidocaine + 10 ml 8.4% sodium bicarbonate) or Protocol B (20 ml 2% lidocaine + 10 ml 0.9% saline solution). A Numeric Rating Scale (0-10) was used to assess the level of pain immediately after the procedure (primary endpoint). Secondary endpoints included pain after 1 h, urinary tract infection, acute urinary retention, and hematuria related to the procedure. Results: A total of 116 patients were randomized. Baseline characteristics (age, sex, indication, and bladder diary parameters) of patients in Group A and B were similar. Pain scores at the end of the procedure were significantly lower with the alkalinized solution (Protocol A and B, respectively, 2.37 ± 0.31 vs. 4.44 ± 0.36, p < .01). No differences were observed 1 h after treatment (Protocol A and B, respectively, 0.54 ± 0.17 vs. 0.69 ± 0.19, p = .487). The only adverse event reported was mild-to-moderate self-limited hematuria in 15.4% of patients. Conclusions: The use of an alkalinized lidocaine solution has proven to be significantly superior to lidocaine only as local anesthesia before intradetrusor BoNTA injection, suggesting that this may be considered a first-line option.

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Randomized controlled trial of belladonna and opiate suppository during intravesical onabotulinum toxin A injection

Cited by 5 publications

References 14 publications

Interventions to improve tolerability of local anesthetic intradetrusor Botulinum toxin injections: A systematic review

Interventions to improve tolerability of local anesthetic intradetrusor Botulinum toxin injections: A systematic review

Urodynamic studies and features of anaesthesia during intradetrusor botulinum therapy in the context of the COVID-19 pandemic (literature review)

Alkalinized lidocaine solution as a first‐line local anesthesia protocol for intradetrusor injection of onabotulinum toxin A: Results from a double‐blinded randomized controlled trial

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