Priyadarshi Vinod, Puri Anurag, Singh Jitendra Pratap, Mishra Shwetank, Pal Dilip Kumar, Kundu Anup Kumar
Department of Urology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
Urol Ann. 2015 Jan-Mar;7(1):67-70. doi: 10.4103/0974-7796.148622.
Urethral meatotomy is an office procedure often done under local anesthesia with or without penile block or under short general anesthesia. Whatever may be the method, the patient has to bear the pain of injection. To avoid painful injections, in the present study, topical anesthesia in the form of eutectic mixture of prilocaine and lidocaine anesthetics (EMLA/Prilox) has been used to perform such procedures and its effectiveness determined.
A total of 48 consecutive patients with meatal stenosis who attended urology outdoor were enrolled in this study. After exclusion, in 32 patients, 3-4 g of Prilox cream was applied over the glans and occlusive covering was maintained for 45 min before the procedure. Meatotomy was done in a standard manner with hemostat application at the stenosed segment for 2-3 min followed by ventral incision at meatus. The patient's pain perception was measured using visual analog score.
Out of 32, only one patient that had inappropriate application of cream, had a perception of pain during the procedure. Rest all the patient had no discomfort during the procedure. Mean visual analog score was 1.8 which is not a significant percepted pain level. No patient had any major complication.
Use of topical anesthesia in form of Prilox (EMLA) cream for meatotomy is safe and effective method that avoids painful injections and anxiety related to it and should be considered in most of such patients as an alternative of conventional penile blocks or general anesthesia.
尿道口切开术是一种常在局部麻醉下进行的门诊手术，可使用或不使用阴茎阻滞麻醉，也可在短时间全身麻醉下进行。无论采用何种方法，患者都要承受注射带来的疼痛。为避免疼痛注射，在本研究中，使用了丙胺卡因和利多卡因麻醉剂的 eutectic 混合物（EMLA/Prilox）形式的局部麻醉来进行此类手术，并确定其有效性。
本研究纳入了 48 例连续就诊于泌尿外科门诊的尿道口狭窄患者。排除后，对 32 例患者在手术前将 3 - 4 g Prilox 乳膏涂抹在龟头，并保持封闭覆盖 45 分钟。以标准方式进行尿道口切开术，在狭窄段用止血钳夹闭 2 - 3 分钟，然后在尿道口进行腹侧切开。使用视觉模拟评分法测量患者的疼痛感知。
32 例患者中，只有 1 例乳膏涂抹不当的患者在手术过程中有疼痛感觉。其余所有患者在手术过程中均无不适。平均视觉模拟评分为 1.8，这不是明显的疼痛感知水平。没有患者出现任何重大并发症。
使用 Prilox（EMLA）乳膏形式的局部麻醉进行尿道口切开术是一种安全有效的方法，可避免疼痛注射及其相关的焦虑，在大多数此类患者中应考虑将其作为传统阴茎阻滞或全身麻醉的替代方法。
