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Craig SS, Seith RW, Cheek JA, Wilson K, Egerton-Warburton D, Paul E, West A. Lidocaine and phenylephrine versus saline placebo nasal spray for the pain and distress of nasogastric tube insertion in young children and infants: a randomised, double-blind, controlled trial. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:391-397. [DOI: 10.1016/s2352-4642(19)30058-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/24/2022]
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Randomized Clinical Trial of Lidocaine Analgesia for Transurethral Bladder Catheterization Delivered via Blunt Tipped Applicator in Young Children. Pediatr Emerg Care 2018; 34:273-279. [PMID: 29232351 DOI: 10.1097/pec.0000000000001358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Transurethral bladder catheterization (TUBC) is a painful, frequently performed procedure for collecting sterile urine. We sought to determine if administration of intraurethral lidocaine before TUBC using a blunt tipped syringe decreases procedural pain in young children in the pediatric emergency department. METHODS Randomized clinical trial of children 0 to 36 months old requiring TUBC for collection of urine in a pediatric emergency department was performed. Patients received intraurethral 2% lidocaine jelly or usual care (no analgesia). Randomization was stratified by sex. Intraurethral lidocaine jelly was administered via Uro-Jet, 5 minutes before TUBC. Baseline child state, lidocaine application, TUBC, and child state 1 minute post-TUBC were videotaped. Neither providers nor parents were blinded to study arm. Videos were scored by a trained, independent, blinded reviewer using the Faces, Legs, Arms, Cry, and Consolability (FLACC) and Modified Behavioral Pain Score scales. Pain scores were compared using the Wilcoxon rank sum test. Our primary outcome was difference in FLACC scores between groups. RESULTS Eighty children were enrolled in the study, and 73 had analyzable data. No differences were detected in pain by mean FLACC score between intervention (8; 95% confidence interval, 7-9) and control (9; 95% confidence interval, 8-10) groups. There were no differences between groups in mean FLACC score when stratified by age or sex or in mean Modified Behavioral Pain Score. CONCLUSIONS Intraurethral lidocaine for TUBC for urine collection using a blunt tipped applicator did not improve procedural pain scores. Pain scores were high across groups. Further study should be performed to improve analgesia for this highly painful procedure.
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Regnier A, Berton I, Concordet D, Douet JY. Effect of topical application of 2% lidocaine gel on corneal sensitivity of clinically normal equine eyes. Vet Anaesth Analg 2018; 45:158-164. [DOI: 10.1016/j.vaa.2017.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/14/2017] [Accepted: 08/31/2017] [Indexed: 11/29/2022]
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Stav K, Siegel YI, Beberashvili I, Sella HZ, Zisman A. Provision of information leaflet before urodynamic study reduces the pre-examination anxiety level. Neurourol Urodyn 2015. [DOI: 10.1002/nau.22799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kobi Stav
- Urology Departement; Assaf Harofeh Medical Center, Zerifin; Affiliated to Sackler School of Medicine; Tel Aviv University; Israel
| | - Yoram I. Siegel
- Urology Departement; Assaf Harofeh Medical Center, Zerifin; Affiliated to Sackler School of Medicine; Tel Aviv University; Israel
| | - Ilia Beberashvili
- Nephrology Departement; Assaf Harofeh Medical Center, Zerifin; Affiliated to Sackler School of Medicine; Tel Aviv University; Israel
| | - Hadas Z. Sella
- Department of Clinical Psychology; Social Science Faculty; the Hebrew Jerusalem University; Jerusalem Israel
| | - Amnon Zisman
- Urology Departement; Assaf Harofeh Medical Center, Zerifin; Affiliated to Sackler School of Medicine; Tel Aviv University; Israel
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Taleschian-Tabrizi N, Farhadi F, Madani N, Mokhtarkhani M, Kolahdouzan K, Hajebrahimi S. Compliance With Guideline Statements for Urethral Catheterization in an Iranian Teaching Hospital. Int J Health Policy Manag 2015; 4:805-11. [PMID: 26673464 DOI: 10.15171/ijhpm.2015.128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 07/09/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND It is believed that healthcare staff play an important role in minimizing complications related to urethral catheterization. The purpose of this study was to determine whether or not healthcare staff complied with the standards for urethral catheterization. METHODS This study was conducted in Imam Reza teaching hospital, Tabriz, Iran, from July to September 2013. A total of 109 catheterized patients were selected randomly from surgical and medical wards and intensive care units (ICUs). A questionnaire was completed by healthcare staff for each patient to assess quality of care provided for catheter insertion, while catheter in situ, draining and changing catheter bags. Items of the questionnaire were obtained from guidelines for the prevention of infection. Data analysis was performed with SPSS 16. RESULTS The mean age of the patients was 50.54±22.13. Of the 109 patients, 56.88% were admitted to ICUs. The mean duration of catheter use was 15.86 days. Among the 25 patients who had a urinalysis test documented in their hospital records, 11 were positive for urinary tract infection (UTI). The lowest rate of hand-washing was reported before bag drainage (49.52%). The closed drainage catheter system was not available at all. Among the cases who had a daily genital area cleansing, in 27.63% cases, the patients or their family members performed the washing. In 66.35% of cases, multiple-use lubricant gel was applied; single-use gel was not available. The rate of documentation for bag change was 79%. CONCLUSION The majority of the guideline statements was adhered to; however, some essential issues, such as hand hygiene were neglected. And some patients were catheterized routinely without proper indication. Limiting catheter use to mandatory situations and encouraging compliance with guidelines are recommended.
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Affiliation(s)
- Negar Taleschian-Tabrizi
- Students' Research Committee, Iranian Evidence-Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fereshteh Farhadi
- Students' Research Committee, Iranian Evidence-Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Madani
- Students' Research Committee, Iranian Evidence-Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohaddeseh Mokhtarkhani
- Students' Research Committee, Iranian Evidence-Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kasra Kolahdouzan
- Students' Research Committee, Iranian Evidence-Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Iranian Evidence-Based Medicine Center of Excellence, Department of Urology, Tabriz University of Medical Sciences, Tabriz, Iran
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Panach-Navarrete J, Martínez-Jabaloyas JM. Is a Retention Time After the Instillation of Anesthetic Lubricant Necessary When Performing Male Flexible Cystoscopy? J Endourol 2015; 29:223-5. [DOI: 10.1089/end.2014.0430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zhao S, Cheng Y, Duan R, Chen Y, Li H. Lidocaine gel should be more effective in reducing urethral pain during urodynamic study in men: Re: Stav K, Taleb E, Sabler IM, Siegel YI, Beberashvili I, Zisman A. Liquid paraffin is superior to 2% lidocaine gel in reducing urethral pain during urodynamic study in men: A pilot study. Neurourol Urodyn. 2014;34:450-3. Neurourol Urodyn 2014; 34:454-5. [PMID: 25307870 DOI: 10.1002/nau.22676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 08/26/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Senming Zhao
- Pain Medicine Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yanxin Cheng
- Pain Medicine Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ran Duan
- Pain Medicine Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yongxue Chen
- Department of Anesthesiology, Handan Center Hospital, Handan, Hebei, China
| | - Hong Li
- Department of Anesthesiology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
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McNicholas CP, Madden T, Zhao Q, Secura G, Allsworth JE, Peipert JF. Cervical lidocaine for IUD insertional pain: a randomized controlled trial. Am J Obstet Gynecol 2012; 207:384.e1-6. [PMID: 23107081 DOI: 10.1016/j.ajog.2012.09.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 07/16/2012] [Accepted: 09/17/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Anticipated pain with intrauterine device (IUD) insertion may be a barrier to widespread use. Our objective was to evaluate the efficacy of intracervical 2% lidocaine gel for pain relief with IUD insertion. STUDY DESIGN We performed a double-blind, randomized controlled trial of women undergoing IUD insertion. Participants were randomly assigned to 2% lidocaine or placebo gel. Study gel (3 mL) was placed 3 minutes prior to IUD insertion. Pain scores were measured at various time points using a 10-point visual analog scale. RESULTS Of the 200 participants randomized, 199 completed the study. Pain scores among lidocaine and placebo arms were similar at tenaculum placement (lidocaine and placebo: median, 4; range, 0-10; P = .15) and with insertion (lidocaine: median, 5; range, 1-10; placebo: median, 6; range, 0-10; P = .16). These results did not differ by parity. CONCLUSION Topical or intracervical 2% lidocaine gel prior to IUD insertion does not decrease pain scores.
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Affiliation(s)
- Colleen P McNicholas
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA.
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Bates DG. VCUG and the recurring question of sedation: preparation and catheterization technique are the key. Pediatr Radiol 2012; 42:285-9. [PMID: 22207139 DOI: 10.1007/s00247-011-2321-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 12/05/2011] [Indexed: 11/29/2022]
Affiliation(s)
- D Gregory Bates
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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Losco G, Antoniou S, Mark S. Male flexible cystoscopy: does waiting after insertion of topical anaesthetic lubricant improve patient comfort? BJU Int 2011; 108 Suppl 2:42-4. [DOI: 10.1111/j.1464-410x.2011.10696.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Visually guided male urinary catheterization: a feasibility study. J Emerg Nurs 2011; 39:27-32. [PMID: 21937096 DOI: 10.1016/j.jen.2011.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 06/04/2011] [Accepted: 07/23/2011] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Ten percent to 15% of urinary catheterizations involve complications. New techniques to reduce risks and pain are indicated. This study examines the feasibility and safety of male urinary catheterization by nursing personnel using a visually guided device in a clinical setting. METHODS The device, a 0.6-mm fiber-optic bundle inside a 14F triple-lumen flexible urinary catheter with a lubricious coating, irrigation port, and angled tip, connects to a camera, allowing real-time viewing of progress on a color monitor. Two emergency nurses were trained to use the device. Male patients 18 years or older presenting to the emergency department with an indication for urinary catheterization using a standard Foley or Coudé catheter were eligible to participate in the study. Exclusion criteria were a current suprapubic tube or gross hematuria prior to the procedure. Twenty-five patients were enrolled. Data collected included success of placement, total procedure time, pre-procedure pain and maximum pain during the procedure, gross hematuria, abnormalities or injuries identified if catheterization failed, occurrence of and reason for equipment failures, and number of passes required for placement. RESULTS All catheters were successfully placed. The median number of passes required was 1. For all but one patient, procedure time was ≤ 17 minutes. A median increase in pain scores of 1 point from baseline to the maximum was reported. Gross hematuria was observed in 2 patients. DISCUSSION The success rate for placement of a Foley catheter with the visually guided device was 100%, indicating its safety, accuracy, and feasibility in a clinical setting. Minimal pain was associated with the procedure.
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A randomized clinical trial of lidocaine gel for reducing infant distress during urethral catheterization. Pediatr Emerg Care 2009; 25:439-43. [PMID: 19564809 DOI: 10.1097/pec.0b013e3181ab7885] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to determine whether a lidocaine-enhanced lubricant that was used topically and instilled into the urethra decreased infants' distress that was associated with catheterization. METHODS Eligible study participants were febrile 2- to 24-month-old pediatric emergency department patients in need of a catheter-obtained urinalysis. Patients were randomly assigned to 1 of 3 groups. Patients had catheterization performed after a 4-minute protocol that included a topical lubricant control, topical and intraurethral lubricants, or topical and intraurethral lidocaines. All patients were filmed during the procedure and evaluated at 3 phases: the start of the study, time of instillation, and at the time of maximal catheter insertion. The 3 phases were analyzed by blinded coders using the Modified Behavioral Pain Scale. RESULTS A total of 45 patients were enrolled in 1 of the 3 study groups. Patients who received lidocaine had a lower overall distress at a level approaching significance at the time of catheterization (phase 3; P = 0.065) and a significantly lower distress as measured by crying during the catheterization (phase 3; P = 0.036) than infants who did not have a lubricant instilled into the urethra. CONCLUSIONS The use of topical and intraurethral lidocaine resulted in a lower distress when compared with a topical lubricant, at a level approaching significance for global distress. When a subsection of the total distress score that measured infant cry was evaluated, the difference between the intraurethral lidocaine group and the group without intraurethral instillation was statistically significant. Although the results are promising, intraurethral lidocaine did not fully alleviate discomfort associated with urethral catherization. The use of lidocaine is suggested for pediatric patients undergoing urethral catherization; however, evaluation of additional agents and techniques for further decreasing pain is also warranted.
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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. [PMID: 18782206 DOI: 10.1111/j.1742-6723.2008.01105.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The product information for local anaesthetic (lignocaine) gel recommends a delay of 'several minutes' between gel instillation and urethral catheterization in men. However, pilot data indicate that approximately half of physicians omit this delay. We aimed to compare the discomfort of urethral catheterization performed immediately or after a 2 min delay following instillation of local anaesthetic gel. METHODS We undertook a randomized, controlled, single-blinded, clinical trial in four large ED. A convenience sample of men requiring urethral catheterization for urinary retention or output monitoring was enrolled. Participants were randomized to catheterization either immediately (no delay group) or after a 2 min delay (2 min delay group) following the instillation of local anaesthetic gel. The pain score of catheterization was recorded immediately following the catheterization, using a 100 mm visual analogue scale. RESULTS Seventy-three patients were enrolled. There were 36 and 37 patients randomized to the no delay and 2 min delay groups, respectively. There was no significant difference between the two groups in mean patient age (71.5 +/- 15.1 vs 69.2 +/- 15.2 years, respectively, P = 0.53) or in the indication for catheterization (retention 29 vs 27, respectively, P = 0.62). There was no statistically significant difference in pain scores between the two groups. The median (interquartile range) pain scores were 22.2 (23.4) and 27.8 (35.3) for the no delay and the 2 min delay groups, respectively (P = 0.47). CONCLUSION A 2 min delay following instillation of local anaesthetic gel before urethral catheterization in men does not decrease the pain of the procedure.
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Abstract
Lubricants are used for catheterization and/or endoscopic maneuvers. "The lubricant" should guarantee sufficient lubrification of the urinary tract, good visualization during endoscopy, and excellent local anesthesia. Additionally, asepsis or reliable control of the local bacterial flora of the urethra should be ensured. Modern lubricants fulfil these recommendations; in addition, they provide therapeutic opportunities for local therapy, for instance, of non-gonococcal urethritis. The latest results show that there are a few lubricants with antimicrobiotic influence on MRSA (methicillin-resistant Staphylococcus aureus), which is of great importance because of the steady increase in MRSA-dependent infections.
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Affiliation(s)
- H Sperling
- Urologische Klinik, Universitätsklinikum, Essen.
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