Poletajew Sławomir, Bender Sylwia, Pudełko Paweł, Łykowski Marcin, Piecha Tomasz, Sutkowski Bartosz, Radziszewski Piotr
Department of Urology, Medical University of Warsaw, Warsaw, Poland.
Wideochir Inne Tech Maloinwazyjne. 2017;12(1):75-80. doi: 10.5114/wiitm.2017.66506. Epub 2017 Mar 13.
Standard intra-urethral instillation of anaesthetic gel may not sufficiently exclude pain perception during cystoscopy.
To evaluate the impact of the anaesthesia within the posterior urethra on pain intensity related to cystoscopy in men.
One hundred and twenty-seven men undergoing cystoscopy were prospectively enrolled in the study. Patients were randomly assigned to the experimental or control group (66 vs. 61 patients). Intra-urethral instillation of 2% lidocaine gel was done in both groups. In the experimental group, the posterior urethra was additionally anaesthetized with distribution of the lidocaine gel by catheterisation. The study endpoints were pain intensity at successive time points of the procedure assessed on a numeric rating scale, overall pain intensity assessed on a Likert scale, the need for analgesics during 6 h after the procedure, and the frequency of urinary tract infections (UTIs) during 14 days after the procedure.
Pain perception during cystoscopy did not differ significantly between the two groups (p > 0.05). However, after 6 h patients in the experimental group were more likely to declare that the cystoscopy was painless (81.8% vs. 70.2%, relative risk = 1.17). The need for analgesics and the incidence of UTI were similar in both groups (p > 0.05). Statistically significant differences regarding pain perception were observed depending on patients' age and the number of transurethral procedures performed in the past, with no relation to type of anaesthesia (p < 0.05).
Anaesthesia of the posterior urethra is not more efficacious in reducing pain related to cystoscopy than standard instillation of anaesthetic gel. However, it improves the general perception of the procedure, and hence may positively influence patients' compliance.
标准的尿道内麻醉凝胶滴注可能无法充分排除膀胱镜检查期间的疼痛感知。
评估后尿道麻醉对男性膀胱镜检查相关疼痛强度的影响。
前瞻性纳入127例接受膀胱镜检查的男性患者。患者被随机分配到实验组或对照组（66例对61例）。两组均进行2%利多卡因凝胶的尿道内滴注。在实验组中，通过导管插入术将利多卡因凝胶分布于后尿道，对其进行额外麻醉。研究终点包括在程序连续时间点使用数字评分量表评估的疼痛强度、使用李克特量表评估的总体疼痛强度、术后6小时内对镇痛药的需求以及术后14天内尿路感染（UTI）的发生率。
两组在膀胱镜检查期间的疼痛感知无显著差异（p>0.05）。然而，6小时后，实验组患者更有可能宣称膀胱镜检查无痛（81.8%对70.2%，相对风险=1.17）。两组对镇痛药的需求和UTI的发生率相似（p>0.05）。根据患者年龄和过去进行的经尿道手术次数观察到疼痛感知存在统计学显著差异，与麻醉类型无关（p<0.05）。
后尿道麻醉在减轻膀胱镜检查相关疼痛方面并不比标准的麻醉凝胶滴注更有效。然而，它改善了对该程序的总体感受，因此可能对患者的依从性产生积极影响。
