EFFECTS OF INTRAURETHRAL LIDOCAINE ANESTHETIC AND PATIENT ANXIETY ON PAIN PERCEPTION DURING CYSTOSCOPY

Despite current practice there is no evidence to demonstrate the effic acy of intraurethral lidocaine gel as an anesthetic for rigid cystosco py. To evaluate the usefulness of lidocaine in decreasing pain associa ted with cystoscopy, we performed a prospective, randomized, controlle d, double-blind study comparing lidocaine gel with a water based lubri cant. The effects of pre-procedure anxiety and prior experience with c ystoscopy on pain perception were also evaluated. Physician perception of pain experienced by the patient was compared with the actual pain experienced. We found no decrease in pain perception in men or women f ollowing lidocaine gel instillation with a 5 or 10-minute dwell time c ompared to instillation of the plain lubricant. Increased preprocedure anxiety correlated with increased pain perception in women. Personal experience with prior cystoscopic procedures significantly decreased t he current pain perception in men. Physicians underestimated the patie nt pain perception in all groups. Overall, we found the use of lidocai ne gel to be of no benefit in routine rigid cystoscopy. Lowering pre-p rocedure anxiety may decrease the amount of pain perceived by women bu t not by men.