title: Does lidocaine gel alleviate the pain of bladder catheterization in young children? A randomized, controlled trial.
abstract: OBJECTIVE
  Bladder catheterization (BC) is a commonly performed, painful procedure in the pediatric emergency department (ED). A survey demonstrated that analgesia is infrequently used for several brief painful procedures, including BC, in pediatric patients. In this study, we evaluated the use of 2% lidocaine gel to alleviate the pain associated with BC in young children (<2 years) in the ED.
  
  
  METHODS
  We conducted a randomized, double-blind, placebo-controlled trial comparing pain scores during bladder catheterization with 2% lidocaine gel versus nonanesthetic lubricant. We used a previously validated scale for measuring brief procedure-related pain in preverbal children (Face Legs Arms Cry Consolability Pain Scale [FLACC]). A total of 115 patients were recruited; 56 patients were randomized to the control group, and 59 were randomized to the lidocaine group. Lubricant was applied to both the genital mucosa and the catheter. Pain measurements were recorded at 3 time intervals: before insertion of the catheter, during catheterization, and after catheterization. Interobserver reliability had been previously established in an observational pilot study.
  
  
  RESULTS
  The difference in mean FLACC scores between the control (7.55 +/- 2.56) and study groups (7.37 +/- 2.87) during catheterization was not statistically significant. The change in FLACC from time 1 (preprocedure) to time 2 (during procedure) was statistically significant in both groups, suggesting that bladder catheterization is a painful procedure.
  
  
  CONCLUSIONS
  Altering the standard practice of use of nonanesthetic lubricant with 2% lidocaine gel as lubricant during bladder catheterization in young children may not be helpful in alleviating the pain associated with the procedure.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, University of Tennessee Health Sciences Center, Le Bonheur Children's Medical Center, Memphis, TN, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Vaughan
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Paton
authors.forename: Andrew
authors.initials: A
authors.lastname: Bush
authors.forename: Jay
authors.initials: J
authors.lastname: Pershad
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005782:Gels; D006801:Humans; D007223:Infant; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D001743:Urinary Bladder; D014546:Urinary Catheterization / Q000009:adverse effects*
chemical_list: D000779:Anesthetics, Local; D005782:Gels; D008012:Lidocaine