Lidocaine jelly and plain aqueous gel for urethral straight catheterization and the Q-tip test: a randomized controlled trial.
OBJECTIVE
To compare the pain perception between lidocaine and plain aqueous gel during assessment of postvoid residual volume and the Q-tip test.


METHODS
: Patients were randomly assigned to either to 2% lidocaine hydrochloride jelly or plain aqueous gel. The allocated gel was first used to lubricate a catheter that was inserted into the bladder to measure the postvoid residual volume. After removal of the catheter, a cotton swab, coated with the same allocated gel, was advanced to the urethrovesical junction until resistance was felt. The angle of the swab with the horizontal plane was measured at rest and with Valsalva maneuver. Relevant baseline characteristics and the Wong-Baker FACES pain scores (where 0 is for no pain and 5 for worst pain) were compared.


RESULTS
After randomization, lidocaine and the plain aqueous gel arms consisted of 69 and 68 women, respectively. Baseline characteristics of the groups were similar. Significantly fewer women in the lidocaine group (62.3%) reported any pain than those allocated to plain aqueous gel (80.9%) (odds ratio 0.39, 95% confidence interval 0.18-0.85). The median pain score was significantly lower in the lidocaine group (1, range 0-5) compared with 2 (range 0-4), P<.001).


CONCLUSIONS
When compared with plain aqueous gel, 2% lidocaine jelly significantly reduces pain perception during evaluation of postvoid residual volume and the Q-tip test.


METHODS
I.
Harmanli
Ozgur H
OH
From the Department of Obstetrics and Gynecology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts.
Okafor
Obi
O
Ayaz
Reyhan
R
Knee
Alexander
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000627:therapeutic use*; D005260:Female; D005782:Gels; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use*; D008875:Middle Aged; D010146:Pain / Q000209:etiology* / Q000517:prevention & control*; D010147:Pain Measurement; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000009:adverse effects*; D014549:Urinary Incontinence / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D014636:Valsalva Maneuver
D000779:Anesthetics, Local; D005782:Gels; D008012:Lidocaine
Crystle CD, Charme LS, Copeland WE. Q-tip test in stress urinary incontinence. Obstet Gynecol 1971;38:313–5.
Woodward S. Use of lubricant in female urethral catheterization. Br J Nurs 2005;14:1022–3.
Swift SE, Bent AE. Basic evaluation of the incontinent female patient. In: Bent AE, Ostergard DR, Cundiff GW, Swift SE, editors. Ostergard’s urogynecology and pelvic floor dysfunction. Philadelphia (PA): Lippincott Williams & Wilkins; 2003. p. 69–76.
Wai CY. Urinary incontinence. In: Schorge JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG, editors. Williams gynecology. New York (NY): McGraw-Hill; 2008. p. 512–31.
Lentz GM. Urogynecology. In: Katz VL, Lobo RA, Lentz GM, Gershenson DM. Comprehensive gynecology. Philadelphia (PA): Mosby; 2007. p. 537–68.
Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs 1988;14:9–17.
Weber Lebrun EE, Harmanli OH, Lidicker J, Dandolu V. Can we use a catheter to do the Q-tip test? Obstet Gynecol 2007;110:1297–300.
Panknin HT, Althaus P. Guidelines for preventing infections associated with the insertion and maintenance of short-term indwelling urethral catheters in acute care. J Hosp Infect 2001;49:146–7.
Berde CB, Strichartz GR. Local anesthetics. In: Miller RE, editor. Anesthesia. 5th ed. New York (NY): Churchill Livingstone; 2000. p. 491–522.
Chung C, Chu M, Paoloni R, O’Brien MJ, Demel T. Comparison of lignocaine and water-based lubricating gels for female urethral catheterization: a randomized controlled trial. Emerg Med Australas 2007;19:315–9.
Tanabe P, Steinmann R, Anderson J, Johnson D, Metcalf S, Ring-Hurn E. Factors affecting pain scores during female urethral catheterization. Acad Emerg Med 2004;11:699–702.
Garbutt RB, McD Taylor D, Lee V, Augello MR. Delayed versus immediate urethral catheterization following instillation of local anaesthetic gel in men: a randomized, controlled clinical trial. Emerg Med Australas 2008;20:328–32.
Van der Burght M, Schønemann NK, Laursen JK, Arendt-Nielsen L, Bjerring P. Onset and duration of hypoalgesia following application of lidocaine spray on genital mucosa. Acta Obstet Gynecol Scand 1994;73:809–11.