Randomized Double-Blind Comparison of Lidocaine Gel and Plain Lubricating Gel in Relieving Pain During Flexible Cystoscopy

Chen, Y.T.; Hsiao, Po‐Jen; Wong, Wai-Yan; Wang, C.C.; Yang, Stephen Shei Dei; Hsieh, Cheng-Han

doi:10.1016/s0022-5347(05)00856-6

Cited by 12 publications

(26 citation statements)

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“…Five studies conclude that lignocaine gel has no effect on pain perception during cystoscopy [5,6,[8][9][10]. The study of Birch et al [5] evaluated pain perception only during flexible cystoscopy by an experienced urologist in 138 men.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the demand for analgesics after cystoscopy was evaluated; in the lignocaine group, 12 of 45 patients requested analgesics after instrumentation, compared with six of 46 patients having plain aqueous gel ( P = 0.103). Chen et al [9] recommended studies with more patients, as the differences were not statistically significant.…”

Section: Anaesthetic Efficacy Of Local Anaesthetic Lubricant In Fleximentioning

confidence: 99%

“…Several papers report studies of discomfort and pain during diagnostic cystoscopy [5,6,[8][9][10][11][12][13]. In a prospective, randomized, double-blind study, Birch et al [5] examined the discomfort of flexible cystoscopy in 138 men; 10 mL of 2% lignocaine gel or 10 mL of plain aqueous gel were injected into the urethra 10-15 min before cystoscopy.…”

Section: Anaesthetic Efficacy Of Local Anaesthetic Lubricant In Fleximentioning

confidence: 99%

“…Other studies of flexible cystoscopy in men, questioned the pain-reducing effect of lignocaine gel [8][9][10]. McFarlane et al [8] randomized, in a double-blind, placebocontrolled trial, 60 men into three different groups, receiving 20 mL of placebo gel (group I), 10 mL of 2% lignocaine gel (group II) and 20 mL of 2% lignocaine gel (group III).…”

Section: Anaesthetic Efficacy Of Local Anaesthetic Lubricant In Fleximentioning

confidence: 99%

“…In a randomized, double-blind study, Chen et al [9] compared the pain-reducing effect of 20 mL 2% lignocaine gel (45 men) vs 20 mL plain aqueous gel (46 men) for flexible cystoscopy; the mean ( SD ) pain scores were similar in the two groups, at 2.8 (1.1) and 2.5 (1.1), respectively ( P = 0.06). In addition, the demand for analgesics after cystoscopy was evaluated; in the lignocaine group, 12 of 45 patients requested analgesics after instrumentation, compared with six of 46 patients having plain aqueous gel ( P = 0.103).…”

Section: Anaesthetic Efficacy Of Local Anaesthetic Lubricant In Fleximentioning

confidence: 99%

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Effects of intraurethral injection of anaesthetic gel for transurethral instrumentation

Schede

Thüroff

2006

BJU International

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receiving plain aqueous gel than in those receiving lignocaine gel.However, in both studies the authors admitted a lack of statistical power because there were too few subjects in each subgroup. Moreover, the delivery time of lignocaine gel is a critical issue for pain perception during flexible cystoscopy [7]. Injection with lignocaine gel over a period of 10 s causes significantly less urethral discomfort than delivering it over 2 s. The delivery time in the two cited studies was 2 s in [3] and 3 s in [4]. Furthermore, it remains unanswered if the discomfort on delivery of a lubricant before cystoscopy contributes a relevant share to the overall discomfort from the entire instrumentation, e.g. pain from cystoscopy. ANAESTHETIC EFFICACY OF LOCAL ANAESTHETIC LUBRICANT IN FLEXIBLE AND RIGID CYSTOSCOPYSeveral papers report studies of discomfort and pain during diagnostic cystoscopy [5,6,[8][9][10][11][12][13]. In a prospective, randomized, double-blind study, Birch et al. [5] examined the discomfort of flexible cystoscopy in 138 men; 10 mL of 2% lignocaine gel or 10 mL of plain aqueous gel were injected into the urethra 10-15 min before cystoscopy. Pain perception was evaluated immediately after cystoscopy using a VAS. Overall, the study showed no significant difference in pain perception between the groups. Patients having their first cystoscopy had a higher pain perception when plain aqueous gel was used. Because there were few patients in the subgroups (lignocaine gel, 32; plain aqueous gel 22), the differences were not statistically significant.Other studies of flexible cystoscopy in men, questioned the pain-reducing effect of lignocaine gel [8][9][10]. McFarlane et al. [8] randomized, in a double-blind, placebocontrolled trial, 60 men into three different groups, receiving 20 mL of placebo gel (group I), 10 mL of 2% lignocaine gel (group II) and 20 mL of 2% lignocaine gel (group III). Topical exposure over 15 min was secured by using a penile clamp. For pain perception there were no statistically significant differences among the three groups, with mean pain scores in groups I-III of 4.65, 3.93 and 3.57, respectively ( P = 0.406).In a randomized, double-blind study, Chen et al.[9] compared the pain-reducing effect of 20 mL 2% lignocaine gel (45 men) vs 20 mL plain aqueous gel (46 men) for flexible cystoscopy; the mean ( SD ) pain scores were similar in the two groups, at 2.8 (1.1) and 2.5 (1.1), respectively ( P = 0.06). In addition, the demand for analgesics after cystoscopy was evaluated; in the lignocaine group, 12 of 45 patients requested analgesics after instrumentation, compared with six of 46 patients having plain aqueous gel ( P = 0.103). Chen et al. [9] recommended studies with more patients, as the differences were not statistically significant. Stein et al. [6] stratified 236 men and women into four subgroups in a prospective, randomized, double-blind study comparing lignocaine gel and plain aqueous gel, and intraurethral exposure times of 5 and 10 min before rigid cystoscopy. Pain scores measu...

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Section: Discussionmentioning

confidence: 99%

Section: Anaesthetic Efficacy Of Local Anaesthetic Lubricant In Fleximentioning

confidence: 99%

Section: Anaesthetic Efficacy Of Local Anaesthetic Lubricant In Fleximentioning

confidence: 99%

Section: Anaesthetic Efficacy Of Local Anaesthetic Lubricant In Fleximentioning

confidence: 99%

Section: Anaesthetic Efficacy Of Local Anaesthetic Lubricant In Fleximentioning

confidence: 99%

See 3 more Smart Citations

Effects of intraurethral injection of anaesthetic gel for transurethral instrumentation

Schede

Thüroff

2006

BJU International

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Dorsal penile nerve block alleviates pain in men undergoing rigid cystoscopy: A single‐center, randomized, double‐blind, and placebo‐controlled trial

et al. 2021

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Cystoscopy is a kind of invasive manipulation often used by urologists for diagnosis and treatment of bladder cancer and other lower urinary tract diseases. 1 Pain and discomfort is common in men undergoing cystoscopy even under general anesthesia or with topical administration of local anesthetic. [2][3][4] Under general anesthesia, 30% patients complain of pain within 1 week after rigid cystoscopy. 3 In outpatient settings, even with application of a lubricant containing 2% lidocaine, about 76% men suffer from mild to severe pain during rigid cystoscopy, and approximately 27% patients could still feel mild to moderate pain 7 days after the procedure. 4 As for flexible

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Does instillation of lidocaine gel following flexible cystoscopy decrease the severity of post procedure symptoms? A randomised controlled trial assessing the efficacy of lidocaine gel post flexible cystoscopy

et al. 2021

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Objective To assess whether instillation of lidocaine gel both before and after flexible cystoscopy is more effective at reducing post procedural symptoms than instillation of lidocaine gel pre flexible cystoscopy alone. We hypothesise that inadequate urethral dwell time and dilution of lidocaine gel by the irrigation fluid during flexible cystoscopy limits its anaesthetic efficacy. Only one other study has attempted to reduce bothersome urinary symptoms through an intervention after flexible cystoscopy. Methods This was a randomised controlled trial in which patients were randomised 1:1 to receive lidocaine gel pre and post flexible cystoscopy (treatment) or lidocaine gel pre flexible cystoscopy only (control). Patient-reported outcome measures were used to assess symptoms and quality of life prior to cystoscopy, on day 2 and day 7 post cystoscopy. Result Fifty patients were divided equally between the treatment and control groups. There were no significant differences in baseline characteristics between the groups (p = 1.000). An overall symptoms variable was measured, though no significant difference was found in the distribution of responses between the groups at baseline, 2 or 7 days after the flexible cystoscopy (p = 0.423, 0.651,0.735). In the treatment group, 1 patient (4.0%) presented to a doctor for review following flexible cystoscopy, and 4 patients (16.0%) presented in the control group (p = 0.349). Conclusion Initial study results suggest that post-operative lidocaine does not significantly limit the exacerbation of urinary symptoms following flexible cystoscopy; however, our results are not powered to detect a small difference. We do not recommend a change in practice based on our results.

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Randomized Double-Blind Comparison of Lidocaine Gel and Plain Lubricating Gel in Relieving Pain During Flexible Cystoscopy

Cited by 12 publications

References 1 publication

Effects of intraurethral injection of anaesthetic gel for transurethral instrumentation

Effects of intraurethral injection of anaesthetic gel for transurethral instrumentation

Dorsal penile nerve block alleviates pain in men undergoing rigid cystoscopy: A single‐center, randomized, double‐blind, and placebo‐controlled trial

Does instillation of lidocaine gel following flexible cystoscopy decrease the severity of post procedure symptoms? A randomised controlled trial assessing the efficacy of lidocaine gel post flexible cystoscopy

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