Lidocaine lubricant jelly does not reduce pain perception during female urethral catheterization: A systematic review with meta-analysis and trial sequential analysis.

Abstract

The use of lubrication before performing urethral catheterization has been recommended. However, the benefit of using lidocaine gel over plain lubricant gel in reducing pain perception during female urethral catheterization is unclear. With this review, we aimed to compare the pain perception during female urethral catheterization with or without lidocaine lubricant gel. In this study, we systematically searched PubMed, Scopus, Embase, and Web of Science to identify randomized controlled trials (RCTs) comparing 2% lidocaine gel and plain lubricant gel in reducing pain perception during female catheterization. Standard Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed while conducting this review (CRD42020207312). In this review, six RCTs with 464 participants were included. The overall risk of bias for these studies was low. Pain score was presented as standard mean difference (SMD) with a 95% confidence interval (CI). In the overall and subgroup analysis (according to types of pain scores) no significant difference was found between the use of lidocaine and plain lubricant jelly (SMD -0.24 95% CI [-0.96 0.47]). On trial sequential analysis (TSA), by setting alpha=5% and beta=20% for moderate evidence the information size calculated was 440 participants. The cumulative Z-score crossed the TSA line proving the reliability of the results. According to Grading of Recommendations Assessment, Development and Evaluation, the evidence is "moderately" certain. The use of 2% lidocaine gel in female catheterization does not provide a significant reduction in pain perception as compared to plain lubricant gel.