title: The effects of intraurethral lidocaine anesthetic and patient anxiety on pain perception during cystoscopy.
abstract: 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 preprocedure 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.
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: M
authors.initials: M
authors.lastname: Stein
authors.forename: D
authors.initials: D
authors.lastname: Lubetkin
authors.forename: H C
authors.initials: HC
authors.lastname: Taub
authors.forename: W K
authors.initials: WK
authors.lastname: Skinner
authors.forename: J
authors.initials: J
authors.lastname: Haberman
authors.forename: E R
authors.initials: ER
authors.lastname: Kreutzer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control*; D003558:Cystoscopy / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007322:Instillation, Drug; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement / Q000187:drug effects; D011446:Prospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014521:Urethra
chemical_list: D008012:Lidocaine