LIDOCAINE AS TOPICAL ANESTHESIA FOR BLADDER MAPPINGS AND COLD-CUP BIOPSIES

We describe the use of lidocaine as a topical anesthetic for 35 patien ts undergoing random bladder biopsies (bladder mappings) and cold-cup resection of small bladder lesions. Serum lidocaine levels were measur ed 7 to 10 minutes after instillation of the anesthetic using fluoresc ent polarization immunoassay. Adequate pain control was noted in 33 of 35 patients (94%), with negligible serum lidocaine levels noted in al l 35. One patient had a 2 cm. tumor on the anterior wall of the bladde r making resection with topical anesthesia suboptimal and 1 patient re quired 1 mg. supplemental intravenous midazolam hydrochloride to compl ete the procedure. We conclude that topical lidocaine is a safe, inexp ensive and effective mode of anesthesia for bladder mappings and cold- cup biopsies of small bladder lesions. However, it may be inadequate f or lesions large enough to require resection rather than cold-cup biop sy and those at poorly accessible regions of the bladder.