Instillation Of Lidocaine Gel Research Articles

Evaluation of acceptance and preference of topical lidocaine application versus articaine injection anesthesia after nonsurgical periodontal treatment: A randomized clinical trial.

To compare acceptance and preference of topical lidocaine gel anesthesia with articaine injection anesthesia in patients with moderate periodontitis undergoing scaling and root debridement. Ninety-one patients completed this randomized multicenter split-mouth controlled study and underwent two separate periodontal treatment sessions on different days, one with a topical intrapocket lidocaine gel application and the other with an articaine injection anesthesia in a different order depending on randomization. Parameters measured were the patients' preference for topical lidocaine gel anesthesia or injection anesthesia with articaine (primary efficacy criterion), their maximum and average pain, and their intensity of numbness as well as experience of side effects; the probing depth; and the dentists' preference and their evaluations of handling/application, onset and duration of anesthetic effect, and patient compliance. After having experienced both alternatives, 58.3% of the patients preferred the topical lidocaine gel instillation into the periodontal pockets. The safety profile of the lidocaine gel differed positively from the safety profile of articaine injection in type and frequency of adverse drug reactions. The dentists' acceptance and preference regarding either anesthetic method studied were balanced. Instillation of lidocaine gel into the periodontal pocket is a preferred alternative to injection anesthesia for most of the patients and an equivalent alternative for dentists in nonsurgical periodontal therapy.

Effect of Sedation Anesthesia With Intravenous Propofol on Transrectal Ultrasound-Guided Prostate Biopsy Outcomes.

BackgroundSedation anesthesia during transrectal ultrasound (TRUS)-guided prostate biopsy is known to decrease patient pain and anxiety, but little is known whether it affects the procedure’s prostate cancer detection and complication rates. This study aimed to determine the effect of sedation anesthesia with intravenous (IV) propofol on TRUS-guided prostate biopsy outcomes.MethodsA retrospective analysis of 2,119 patients who underwent TRUS-guided prostate biopsy between November 2009 and February 2019 was undertaken. The patients were divided into two groups: patients who underwent sedation anesthesia with IV propofol and patients who underwent local anesthesia with intrarectal lidocaine gel instillation. Cancer detection and complication rates were compared between the two groups. Univariate and multivariate binary logistic regression and multinomial logistic regression analyses were conducted to investigate the effects of sedation anesthesia with IV propofol on prostate cancer detection and complication rates.ResultsThe cancer detection rate of patients in the sedation group was 34.0%, whereas it was 29.2% in the local group (P = 0.024). Multivariate logistic regression analysis regarding factors associated with cancer detection rate after TRUS-guided prostate biopsy in patients with prostate specific antigen (PSA) < 10 showed that IV propofol usage, age, PSA density and core length were significant factors. Multivariate logistic regression analysis regarding factors associated with complications (voiding dysfunction, bleeding and infection) showed that IV propofol usage, age and prostate size were significant factors for voiding dysfunction.ConclusionSedation anesthesia with IV propofol during TRUS-guided prostate biopsy was associated with a higher cancer detection rate than local anesthesia with intrarectal lidocaine gel instillation. Cancer detection rate could be an important factor to consider when selecting for the optimal anesthesia for TRUS-guided prostate biopsy.

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.

ObjectiveTo 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.MethodsThis 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.ResultFifty 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).ConclusionInitial 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.

Comparison of two different doses of lidocaine on the pain sensation during transrectal ultrasound-guided prostate biopsy.

To compare two different doses of lidocaine used for periprostatic nerve block on pain perception during transrectal ultrasound (TRUS) guided prostate biopsy. A total of 288 patients with elevated prostate specific antigen (PSA) levels and/or abnormal digital rectal examination who underwent TRUS-guided prostate biopsy were included in the study. The patients were divided into 3 groups: Group 1 (n=103) prostate biopsy were performed after administering perianal intrarectal application of 10 mL 2% lidocaine gel, Group 2 (n=98) 2 mL of 2% lidocaine injection on each side following rectal installation of lidocaine gel and Group 3 (n=87) 4 mL of 2% lidocaine injection on each side after rectal instillation of lidocaine gel. Patients' pain scores during biopsy procedure were reported using visual analogue score (VAS). Independent sample t test, ANOVA test and Tukey test were used for statistical evaluation. The mean age, prostate volume and PSA level were 65.6±8.4 years, 58.2±34.8 mL, and 11.8±3.4 ng/mL respectively. There were no statistically significant differences in baseline characteristics between the groups. The mean VAS scores were 2.4±1.8 in Group 1, 2.5±1.9 in Group 2 and 1.6±1.6 in Group 3. Patients in Group 3, reported significant pain reduction compared with patients in Groups 1 and 2 (p=0.002, and 0.001, respectively). However, there was no statistically significant difference in VAS scores between Groups 1 and 2 (p=0.815). According to our results we recommend the use of perianal intrarectal lidocain gel application, and periprostatic nerve block with injection of 4 ml 2% lidocaine per side combination in TRUS-guided prostate biopsies. Further large-scale randomized control studies are needed to validate these finding.

Prior Lubrication of the Urethra Does Not Reduce Pain Perception in Men Undergoing Flexible Cystoscopy

Objective: The study aimed to test the hypothesis that the instillation of lidocaine gel does not reduce the pain related to flexible cystoscopy. Material and Methods: A prospective randomized study was designed to compare the pain perception between intraurethral instillation of lidocaine gel and saline solution in flexible cystoscopy. One hundred consecutive male patients attending for flexible cystoscopy were randomized to receive 10 ml of lidocaine gel or 10 ml of saline solution. Saline solution was also used for the irrigation pressure. Patients recorded their pain on a 10 cm Visual Analog Scale before and after the procedure. Patients also assessed whether the cystoscopy was more painful than the previous one. Statistical comparison was made using the t test for parametrical data and the Mann-Whitney U test for non-parametrical data. Results: Mean pain score in the lidocaine group was 0.67 ± 1.11 cm (range 0-5) compared to 0.55 ± 1.10 cm (range 0-5) in the saline solution group. Pain perception did not differ significantly between the 2 groups (mean difference 0.12 cm, 95% CI -0.32 to 0.55, p = 0.40). Conclusions: Prior lubrication of the urethra does not reduce the pain produced during flexible cystoscopy. The introduction of flexible cystoscopes under direct vision and with an irrigation pressure might guarantee sufficient comfort and the lubricant gel instillation could be avoided.

The Effect of Intrarectal Lidocaine Gel Instillation before Transrectal Ultrasound Guided Prostate Biopsy

The Effect of Intrarectal Lidocaine Gel Instillation before Transrectal Ultrasound Guided Prostate Biopsy

AMBULANT FLEXIBLE CYSTOSCOPY FOR FOLLOW-UP OF Ta-TI UROTHELIAL CARCINOMA OF THE URINARY BLADDER: PAIN PERCEPTION AND COST EFFECTIVE.

Ambulant flexible cystoscopy is the standard procedure in the urological practice for follow-up of Ta-T1 urothelial carcinoma (UC) due to its ability to survey the bladder for a variety of indications. It is the principal means of diagnosis and surveillance of bladder tumors. The follow-up of patients treated for Ta-T1 UC is of great importance because of the high incidence of recurrence and progression of the disease, whereby patients with Ta-T1 UC undergo cystoscopy every three months. The aim of this study to evaluate the procedure of ambulant flexible cystoscopy in proper diagnostic follow-up of Ta-T1 UC, patient's acceptance in regard to pain tolerance, non-hospital stay and expenses. Twenty one patients (18 male and 3 female) were diagnosed before as Ta-T1 UC by rigid cystoscopy and transuretheral resection of bladder (TURB) lesion scheduled for follow up by flexible cystoscopy under local anesthesia using 20 ml 2% lidocain gel on an ambulatory bases. Comparison was done using a cohort of 32 patients who underwent the procedure of follow-up of Ta-T1 cystoscopy and TURB using rigid cystoscopy and resectoscope. Seventeen patients 80.9% (16 male and 2 female) proved to be bladder free from recurrent lesion, 4 patients {19.1 %} (3 males and one female) which revealed recurrent lesions in spite of that the urinary bladder was free in pelvic ultrasonography. Cold cup biopsy from the lesions sent for histopathological examination which revealed recurrence of the tumor in 3 patients (two patients with Ta and one patient T1. TURB was done to have complete resection in 4 patients, the histopathological examination revealed ulcerating mucosa and free lamina propria in 3 specimens, and T2 in the fourth specimen. Comparison between the 2 groups revealed more patient's acceptance for the flexible cystoscopy group as regard pain tolerance, non-hospital stay and expenses. Ambulatory flexible cystoscopy with 20 ml of 2% lidocaine gel anesthesia is tolerated well by patients, with advantage of no hospital stay in the regular follow up of Ta-T1 tumors, pain perception was accepted by all patient provided delayed cystoscopy after lidocaine-gel instillation.

Poster 441 Effective Treatment of Hyperhidrosis Secondary to Bowel Program in Spinal Cord Injury: A Case Report

Disclosures: D. Rosenblum, none. Patients or Programs: Hyperhidrosis, or significant sweating, in spinal cord injury can be precipitated by noxious stimuli. The culprit is often ambiguous. It can be associated with autonomic dysreflexia and other conditions such as syrinx. This case is of a 57-year-old woman who sustained C5 ASIA A tetraplegia secondary to trauma. She was stabilized and admitted for further medical and rehabilitative care. She has a neurogenic bladder, neurogenic bowel, and has rarely had dysreflexia episodes. However, shortly after each effective bowel program, she reported chills and excessive hyperhidrosis, with no headache and no hypertension. Her medications included baclofen and Neurontin. Physical examination did not reveal any source of noxious stimuli, such as wounds. A workup revealed normal laboratory tests, and a KUB showed no excessive stool. Magnetic resonance imaging of the spine did not show a syrinx. Different bowel medications, oral and suppositories, including lidocaine gel instillation as well as enemas with anesthetic agents, were unsuccessful in alleviating her symptoms. Scopolamine patch trials were unsuccessful. Tricyclic antidepressant medications, added at night to also help with neuropathic pain, did not impact the hyperhidrosis. Probantheline was provided, with complete resolution of her bowel program–induced hyperhidrosis. Program Description: Use of medication to control hyperhidrosis. Setting: Inpatient rehabilitation unit. Results: Probantheline successfully controlled the patient’s hyperhidrosis. Other medications, as noted, did not. Discussion: Hyperhidrosis is excessive sweating and is seen in people with both tetraplegia and paraplegia. The pathophysiology includes overactivity of the sympathetic nervous system and may be triggered by noxious stimulation. Hyperhidrosis will be reviewed, including the applicable neuroanatomy and sweat gland innervations, as well as workup and treatment approaches. The pharmacology of probantheline is reviewed. Conclusions: Probantheline effectively treated bowel program– induced hyperhidrosis. The mechanism of action of prophantheline, its pharmacology, uses, and adverse effects are reviewed. The prevalence, pathophysiology, differential diagnosis, and treatment options of hyperhidrosis in spinal cord injury are presented.

Meta‐analysis: does lidocaine gel before flexible cystoscopy provide pain relief?

To consolidate previous reports and conduct a meta-analysis to draw further conclusions on the efficacy of the instillation of lidocaine gel before flexible cystoscopy, as it has had varying efficacy in several randomized controlled studies. We reviewed previous reports cited in PubMed, Biosis and the Cochrane Library, identified by a professional librarian searching for English language-only randomized controlled studies involving the keywords, lidocaine, cystoscopy, gel and pain, yielding 14 studies. Ten studies were excluded as they provided no comparison with appropriate control groups or contained insufficient data for analysis. Attempts to contact the authors of these studies yielded no additional data. A meta-analysis was conducted using a random-effects model. Four studies were included in the analysis, two double-blind and two single-blind, totalling 411 male patients. Three of the studies found no statistical improvement and one study found a statistically significant improvement in pain relief using lidocaine gel. Studies varied on the quantity of gel instilled and on the dwell time of gel before cystoscopy. The meta-analysis found that subjects who received anaesthetic-impregnated gel were 1.7 times more likely not to experience moderate to severe pain (<2, 3 or 30, based on the scale used; odds ratio 1.7, 95% confidence interval 1.1-2.8) than subjects who did not have intraurethral instillation of gel. These data suggest that intraurethral instillation of lidocaine gel vs plain lubricating gel reduces the likelihood of moderate to severe pain during flexible cystoscopy.

Nitrous oxide inhalation to improve patient acceptance and reduce procedure related pain of flexible cystoscopy for men younger than 55 years

Purpose: Flexible cystoscopy in men younger than 55 years is painful despite the current best standard anesthesia (20 ml 2% lidocaine gel 15 minutes before endoscopy). The anesthetic value of lidocaine gel is debated and led us to seek an alternative. Nitrous oxide is a well established analgesic and anxiolytic agent, and it significantly reduces pain associated with transrectal ultrasound guided prostate biopsy. We studied its use in flexible cystoscopy in men younger than 55 years.Materials and Methods: A total of 61 patients were prospectively randomized to receive air (31) or Entonox® (30). Both groups had 3 minutes of gas via a breath activated facemask (either Entonox or air) before endoscopy. The gel control group was comprised of 8 patients who underwent cystoscopy after instillation of lidocaine gel. The air and Entonox groups had lidocaine gel as per best standard. Vital signs were recorded before, during and after cystoscopy. Patients completed a visual analog score for gel insertion and cystos...

Nitrous Oxide Inhalation to Improve Patient Acceptance and Reduce Procedure Related Pain of Flexible Cystoscopy for Men Younger Than 55 Years

Flexible cystoscopy in men younger than 55 years is painful despite the current best standard anesthesia (20 ml 2% lidocaine gel 15 minutes before endoscopy). The anesthetic value of lidocaine gel is debated and led us to seek an alternative. Nitrous oxide is a well established analgesic and anxiolytic agent, and it significantly reduces pain associated with transrectal ultrasound guided prostate biopsy. We studied its use in flexible cystoscopy in men younger than 55 years. A total of 61 patients were prospectively randomized to receive air (31) or Entonox (30). Both groups had 3 minutes of gas via a breath activated facemask (either Entonox or air) before endoscopy. The gel control group was comprised of 8 patients who underwent cystoscopy after instillation of lidocaine gel. The air and Entonox groups had lidocaine gel as per best standard. Vital signs were recorded before, during and after cystoscopy. Patients completed a visual analog score for gel insertion and cystoscopy. There were no statistically significant differences between the groups in terms of baseline characteristics. Pain scores for cystoscopy (p<0.001) and intraoperative pulse rate (p=0.008) were significantly less with Entonox. Side effects were transient and seen more often with Entonox (p<0.05). More of the air group would require more analgesia (p=0.001) or a general anesthetic (p=0.011) if undergoing repeat cystoscopy. Nitrous oxide inhalation significantly reduces cystoscopy related pain without significant complications. We propose that Entonox should be the anesthetic agent of choice for men younger than 55 years.

Does the Intrarectal Instillation of Lidocaine Gel Before Periprostatic Neurovascular Bundle Block During Transrectal Ultrasound Guided Prostate Biopsies Improve Analgesic Efficacy? A Prospective, Randomized Trial

We assessed the analgesic effect of additional intrarectal lidocaine gel instillation during transrectal ultrasound guided prostate biopsy and identified the procedural steps that benefit from lidocaine gel instillation. A total of 250 consecutive patients scheduled for prostate biopsy were randomized into 2 groups. In the 125 group 1 patients lidocaine gel was instilled intrarectally before periprostatic neurovascular bundle block. The 125 patients in group 2 underwent only periprostatic neurovascular bundle block without lidocaine gel instillation. Of the 250 patients 90 in group 1 and 113 in group 2, in whom 12 systematic cores were obtained, were enrolled for data analysis. Pain was assessed using a visual analog scale during periprostatic neurovascular bundle block (visual analog scale 1), during biopsy (visual analog scale 2) and 20 minutes after biopsy (visual analog scale 3). Differences between the visual analog scale scores of the 2 groups at each procedural step were evaluated using the unpaired t test with p<0.05 considered significant. In terms of pain experienced during the 3 procedural steps scores were significantly different during biopsy (p<0.01). Visual analog scale scores of patients in group 1 showed a tendency to be lower than the scores of patients in group 2 during periprostatic neurovascular bundle block and 20 minutes after biopsy (p=0.11 and 0.20, respectively). Intrarectal lidocaine gel instillation before periprostatic neurovascular bundle block produces a significant additional analgesic effect during biopsy. The procedure is simple, safe and rapid, and it should be considered in all patients undergoing transrectal ultrasound guided prostate biopsy.

OUTPATIENT FLEXIBLE CYSTOSCOPY IN MEN: A RANDOMIZED STUDY OF PATIENT TOLERANCE

We evaluate the pain of immediate versus delayed outpatient flexible cystoscopy in men after topical local anesthesia application. A total of 100 consecutive men with superficial bladder tumors were randomized to immediate or delayed surveillance flexible cystoscopy after intraurethral instillation of lidocaine gel. Patients recorded the level of pain experienced during cystoscopy on a 4-point pain scale and on a 10-point visual linear analog self-assessment scale. Of the 100 patients 50 underwent immediate and 50 underwent delayed cystoscopy. The mean pain score on a scale of 1-no to 4-severe pain was 1.7 after immediate cystoscopy compared with 1.6 after delayed cystoscopy (p = 0.9). The mean linear analog self-assessment score on a scale of 1-no to 10-most pain was 2.1 after immediate cystoscopy versus 1.8 after delayed cystoscopy (p = 0.7). There was no difference in pain perception in men undergoing immediate or delayed outpatient flexible cystoscopy using the same local anesthetic.

The Effects of Intraurethral Lidocaine Anesthetic and Patient Anxiety on Pain Perception During Cystoscopy

Despite current practice there is no evidence to demonstrate the efficacy of intraurethral lidocaine gel as an anesthetic for rigid cystoscopy. To evaluate the usefulness of lidocaine in decreasing pain associated with cystoscopy, we performed a prospective, randomized, controlled, double-blind study comparing lidocaine gel with a water based lubricant. The effects of pre-procedure anxiety and prior experience with cystoscopy on pain perception were also evaluated. Physician perception of pain experienced by the patient was compared with the actual pain experienced.We found no decrease in pain perception in men or women following lidocaine gel instillation with a 5 or 10-minute dwell time compared to instillation of the plain lubricant. Increased pre-procedure anxiety correlated with increased pain perception in women. Personal experience with prior cystoscopic procedures significantly decreased the current pain perception in men. Physicians underestimated the patient pain perception in all groups. Overall, we found the use of lidocaine gel to be of no benefit in routine rigid cystoscopy. Lowering pre-procedure anxiety may decrease the amount of pain perceived by women but not by men.