UROLITHIASIS, ENDOUROLOGY AND LAPAROSCOPY Randomized Double-Blind Comparison of Lidocaine Gel and Plain Lubricating Gel in Relieving Pain During Flexible Cystoscopy

J Endourol, 19: 163–166, 2005 Purpose: To compare the pain induced by outpatient flexible cystoscopy in men having local lidocaine jelly application or plain lubricant. Patients and Methods: We performed a randomized, double-blind study to compare the anesthetic effect of intraurethral 2% lidocaine gel (N 45) and plain lubricant (N 46) in men undergoing outpatient flexible cystoscopy. The age, prostate size, and examination time were similar in the two groups. Before cystoscopy, we filled the urethra with 20 mL of gel, which was held for 15 minutes. A 15.5F flexible cystoscope was then used for examination. A 10-point visual analog pain scale (1 least to 10 most painful) and a four-point pain grade (grade 1 least to grade 4 most painful) were used to measure the pain perception. The amount of postoperative analgesic used and willingness to adopt the same anesthesia for future cystoscopy were also recorded. Results: The mean pain scores for the lidocaine and plain gel groups were 2.8 1.1 and 2.5 1.1, respec-tively (P 0.06), while the pain grades for the lidocaine gel and plain gel groups were 1.6 0.6 and 1.8 0.7, respectively (P 0.19). In both groups, many patients (42.2% in the lidocaine gel group and 37% in the plain lubricant group) felt the external sphincter and prostatic urethra were the most uncomfortable areas during cystoscopy. Postcystoscopic analgesics were requested by 12 of 45 patients in the lidocaine group, but only 6 of 46 of the plain-gel group (P 0.103). When patients were asked if they would desire general anes-thesia for better pain control in future examinations, five of the lidocaine group responded positively, while three of the plain-gel group said they would (P 0.62). The cost of lidocaine gel is about thrice that of the plain gel. Conclusion: Using plain lubricant is cheaper and faster than applying lidocaine gel. The pain score, pain grade, postcystoscopic analgesic requirement, and anesthetics requested for the next cystoscopy were similar in the two groups. However, a larger investigation will be needed to achieve more significant statistical power. Editorial Comment: Save your money! Lidocaine gel as an anesthetic before flexible cystoscopy is not worth its weight in plain lubricant. In actuality, it is 3 times more expensive. Indeed, whether you give 10 or 20 ml, or whether you wait the 15 minutes needed for it even to begin to work, makes no difference. 1 All that happens is you are wasting precious office time, incurring additional expense and providing your patient no benefit. Also noteworthy is that the authors document what many might consider the obvious—the areas of greatest discomfort during flexible cystoscopy are the external sphincter and the prostatic urethra. It is not clear to me that the lidocaine gel even reaches these areas.