A Randomized Clinical Trial of Lidocaine Gel for Reducing Infant Distress During Urethral Catheterization

Abstract

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.

The New American Academy of Pediatrics Urinary Tract Infection Guideline

“…Although bag urine cultures can lead to errors, catheterized urine cultures are not perfect 1 and urethral catheterization is painful, 8 frightening, 9 and risks introducing infection. 10 Fortunately, if other recommendations in the guideline are followed (including the elimination of routine voiding cystourethrograms [VCUGs] and outpatient rather than inpatient antimicrobial therapy; see below), the adverse consequences of falsely positive bag cultures will be markedly attenuated.…”

Intraurethral Lidocaine for Urethral Catheterization in Children: A Randomized Controlled Trial

“…41,42 Studies in younger children, however, are consistent with our findings. Mularoni et al 22 found no significant differences on a global measure of distress in children aged 2 to 24 months undergoing UC. The authors concluded that the administration time of 2 minutes might not have been sufficient for optimal analgesia.…”

“…It is widely held that UC is painful for both children [17][18][19]22,23 and adults. 39 The suggested practice to reduce UC-related discomfort in children has typically included instillation of an anesthetic gel.…”

“…This uncertainty may be explained by the conflicting results of pediatric trials of topical analgesia. These inconsistencies could be due to suboptimal application times, restraining the infant, small sample sizes, 21,22 or exclusively topical administration. 23 The importance of providing optimal pain treatment is echoed by both the World Health Organization 24 and the American Academy of Pediatrics, 25 who recently reaffirmed its advocacy for adequate analgesia for painful procedures in children.…”

“…The latter was delivered by a trained research nurse by using a 3-mL plastic syringe attached to a 25-gauge angiocatheter and inserted 5 mm into the distal urethra. As previously described, 22 children ,7 kg and $7 kg received 1 mL and 1.5 mL of intraurethral lidocaine, respectively. Five minutes were allowed to elapse from the time of intraurethral lidocaine administration to UC.…”