MP52-12 SODIUM BICARBONATE TO AUGMENT LIDOCAINE'S INTRAVESICAL ACTIVITY: A RANDOMIZED, CROSSOVER STUDY

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II (MP52)1 Sep 2021MP52-12 SODIUM BICARBONATE TO AUGMENT LIDOCAINE'S INTRAVESICAL ACTIVITY: A RANDOMIZED, CROSSOVER STUDY Michael Goltzman, Dylan Buller, Brendan Gontarz, Suzanne Roman, and Gerard Pregenzer Michael GoltzmanMichael Goltzman More articles by this author , Dylan BullerDylan Buller More articles by this author , Brendan GontarzBrendan Gontarz More articles by this author , Suzanne RomanSuzanne Roman More articles by this author , and Gerard PregenzerGerard Pregenzer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002082.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are multiple indications for intravesical botulinum toxin-A (BTX-A) injections. Local anesthetic has been used to improve discomfort experienced during intradetrusor injections. Alkalization of local anesthetic has improved its efficacy in other areas of the human body. We sought to study its effects in the naturally acidic environment of the bladder. The purpose of the study was to determine if there is a difference in pain perception during BTX-A injection when utilizing alkalinized lidocaine versus lidocaine alone. METHODS: This study was an IRB-approved, prospective, randomized controlled trial with a crossover design conducted by a single urologist in the office setting. Patients with indications for intravesical BTX-A injections and possessing the cognitive ability to report subjective pain scores were eligible. On the first procedure, patients were randomized to either the control or intervention group. Controls received 50mL of 2% lidocaine alone, whereas the intervention group received a mix of 50mL of 2% lidocaine with 5mL of 8.4% sodium bicarbonate. On the second visit, 4-6 months later, participants would be switched to their opposite group to act as their own controls. On the third visit all patients received the intervention. Subjective pain was the primary outcome, assessed by identical pain questionnaires, including a qualitative measure of pain as per a visual analog pain scale (VAS). RESULTS: Twenty-six of the 33 patients (13 men, 20 women; mean age: 59.5 years) received 2 procedures and 16 received a 3rd procedure. Of the 68 procedures, 26 were in the control arm and 42 intervention. Subjective pain score at first injection was significantly lower in the intervention arm (2.31 vs 3.81; p=0.028). Pain throughout the procedure was lower in the intervention arm although not significant (2.08 vs 2.75; p=0.258). There were no adverse events noted during the study. CONCLUSIONS: In our cohort, those who received the sodium bicarbonate experienced less pain at first injection compared to those subject to lidocaine alone. Although subjective pain scores vary between patients, acting as their own controls limits this bias. With no adverse events and no significant alterations to the office-based procedure, we found sodium bicarbonate is an effective and cost-conscious augmentation to lidocaine instillation for BTX-A therapy. Buffering of lidocaine has a greater likelihood of achieving successful anesthesia which may promote further treatment adherence. Source of Funding: This research received no specific grant from any funding agency © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e934-e934 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Goltzman More articles by this author Dylan Buller More articles by this author Brendan Gontarz More articles by this author Suzanne Roman More articles by this author Gerard Pregenzer More articles by this author Expand All Advertisement Loading ...