Factors affecting pain scores during female urethral catheterization.
OBJECTIVE
To compare pain and discomfort ratings of female patients undergoing urethral catheterization randomized to topical application of plain lubricant versus lidocaine gel prior to the procedure.


METHODS
This was a prospective, randomized, double-blind study involving female patients requiring urethral catheterization at an urban university-based academic emergency department. A staff nurse blinded to the lubricant type injected 5 mL of sterile surgical lubricant or 2% lidocaine gel into the urinary meatus. After 1 minute, an 8-F (for specimen collection) or a 16-F (for continuous collection) catheter was inserted into the urethra. Each patient rated the pain of the procedure on a validated 0- to 100-mm visual analog scale. The Mann-Whitney U test was used to analyze associations between pain ratings, lubricant type, and catheter size. Logistic regression was used to identify the contribution of lubricant type, catheter size, age category, difficulty of insertion, preprocedural pain, and diagnosis of urinary tract infection to procedural pain rating.


RESULTS
One hundred women were randomized to plain lubricant (n = 50) or lidocaine (n = 50). The overall mean ( +/- SD) pain score was 23.5 +/- 27.2 mm. No significant differences in pain ratings were found based on catheter size or lubricant type. Younger women, aged 18-59 years, experienced higher pain ratings than women aged 60-101 (mean pain difference 14.4 mm; 95% CI = 4.3 to 24.5; p < 0.006). Multiple logistic regression identified preprocedural pain as the only predictor of higher pain rating after catheterization (OR 1.02; 95% CI = 1.002 to 1.039, p = 0.03).


CONCLUSIONS
Catheter size and lubricant type did not affect the severity of pain after urethral catheterization in women.
Tanabe
Paula
P
Institute for Health Services Research and Policy Studies and Division of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA. p-tanabe@northwestetrn.edu
Steinmann
Rebecca
R
Anderson
Jill
J
Johnson
Deborah
D
Metcalf
Sue
S
Ring-Hurn
Eileen
E
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002408:Catheters, Indwelling / Q000009:adverse effects; D004311:Double-Blind Method; D004867:Equipment Design; D005260:Female; D005782:Gels; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008153:Lubrication; D008875:Middle Aged; D010146:Pain / Q000145:classification* / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D011446:Prospective Studies; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*
D000779:Anesthetics, Local; D005782:Gels; D008012:Lidocaine