Randomized, prospective, double-blind study of the effects on pain perception of lidocaine jelly versus plain lubricant during outpatient rigid cystoscopy
Randomized, prospective, double-blind study of the effects on pain perception of lidocaine jelly versus plain lubricant during outpatient rigid cystoscopy
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DOI：
10.1016/s0022-5347(01)65292-3
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发表时间：
1997-01-01
影响因子：
6.6
通讯作者：
Gerber, GS
中科院分区：
文献类型：
--
作者：
Goldfischer, ER;Cromie, WJ;Gerber, GS
目的：没有明确的证据表明尿道内利多卡因凝胶可以减轻疼痛和/或使患者更能耐受硬性膀胱镜检查。由于利多卡因果冻是显着更昂贵的比普通润滑剂，我们试图评估这个agent.Materials和方法的真正好处：我们进行了一项随机，前瞻性，双盲研究，比较麻醉效果的尿道内2%利多卡因果冻与普通润滑剂在接受刚性膀胱镜检查的患者。与以前的研究不同，我们通过使用30 cc的每种药物来确保充分的尿道填充，并且在滴注药物后等待20分钟，然后进行膀胱镜检查以允许充分吸收。使用17至21 F刚性器械进行膀胱镜检查。共有189名患者进入研究，但10名患者因问卷不完整而被排除在分析之外。使用10点量表（1-最少到10-最痛苦）来测量疼痛感知。结果：当使用利多卡因凝胶时，男性的疼痛感知显著降低（平均值±标准误3.00 +/- 0.21与4.36 +/- 0.37点，p = 0.002）。在女性中，当使用利多卡因凝胶或普通润滑剂时，没有观察到疼痛感知的差异（3.21 +/- 0.38与3.11 +/- 0.30分，p = 0.823）。患者种族、相关操作的性能、膀胱镜尺寸或膀胱镜检查史对报告的疼痛评分无显著影响。随着年龄的增长，疼痛感知略有下降（每十年-0.23 +/-0.10分，p = 0.021）。膀胱镜检查前患者的焦虑水平也与疼痛感显著相关（p < 0.001）。结论：利多卡因凝胶在女性硬性膀胱镜检查期间的疼痛控制方面与普通润滑剂相比没有优势。然而，当使用足够的量，并允许在膀胱镜检查前在尿道停留20分钟时，利多卡因凝胶可以显着减轻男性的疼痛。
Purpose: There is no clear evidence that intraurethral lidocaine jelly decreases pain and/or makes rigid cystoscopy more tolerable for patients. Since lidocaine jelly is significantly more expensive than plain lubricant, we attempted to assess the true benefit of this agent.Materials and Methods: We performed a randomized, prospective, double-blind study to compare the anesthetic effects of intraurethral 2% lidocaine jelly versus plain lubricant in patients undergoing rigid cystoscopy. Unlike previous studies, we ensured adequate urethral filling by using 30 cc of each agent and we waited 20 minutes after instillation of the agent before performing cystoscopy to allow adequate absorption. Cystoscopy was performed using a 17 to 21F rigid instrument. A total of 189 patients was entered into the study but 10 were excluded from analysis due to incomplete questionnaires. A 10-point scale (1-least to 10-most painful) was used to measure pain perception.Results: In men pain perception was significantly decreased when lidocaine jelly was used (mean plus or minus standard error 3.00 +/- 0.21 versus 4.36 +/- 0.37 points, p = 0.002). In women there was no observed difference in pain perception when lidocaine jelly or plain lubricant was used (3.21 +/- 0.38 versus 3.11 +/- 0.30 points, p = 0.823). Patient race, performance of a related procedure, cystoscope size or history of cystoscopy did not significantly affect reported pain scores. There was a slight decrease in pain perception with increasing age (-0.23 +/- 0.10 points per decade, p = 0.021). The level of patient anxiety before cystoscopy was also significantly associated with pain perception (p < 0.001).Conclusions: Lidocaine jelly offers no advantage over plain lubricant in regard to pain control during rigid cystoscopy in women. However, when used in adequate amounts and allowed to dwell in the urethra for 20 minutes before cystoscopy, lidocaine jelly can significantly decrease pain in men.