Alkalinized lidocaine versus lidocaine gel as local anesthesia prior to intra‐vesical botulinum toxin (BoNTA) injections: A prospective, single center, randomized, double‐blind, parallel group trial of efficacy and morbidity

Nambiar, Arjun; Younis, Ayman; Khan, Zainab; Hildrup, Iona; Emery, Simon; Lucas, Malcolm G

doi:10.1002/nau.22750

Cited by 9 publications

(12 citation statements)

References 8 publications

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“…In another randomized clinical trial study that compared the efficacy of alkalinized lidocaine (AL) solution (10 mL 8.4% sodium bicarbonate and 20 mL 2% lidocaine solution and 22 mL sterile Aquagel) and lidocaine gel (LG) (22 mL standard 2% lidocaine gel Instillagel 1 and 30 mL 0.9% normal saline solution) on reducing the pain of a botulinum toxin injection on 54 patients, both of the anesthetic materials acted the same . Although theoretically alkalization of the anesthetic solution increases its diffusion through the cell membrane, in the clinical study, it did not prove superior and it cost twice as much as lidocaine gel …”

Section: Local Anesthesiamentioning

confidence: 99%

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A mini review on the common methods of pain reduction before filler and botulinum toxin injection

Fallahi

Keyhan

Zandian

et al. 2019

J of Cosmetic Dermatology

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Background As the desire for beauty and youthful appearance has increased in recent years, cosmetic injections are getting more attention. However, patients discomfort during these injections is a challenging issue. Aim This review explores common approaches to reduce pain and discomfort during cosmetic injections through the available literature. Methods The eligible studies through searching in PubMed have been entered to evaluate the common methods of pain reduction for cosmetic injections. Results According to reviewed studies, vibration, local anesthesia, and vapocoolant anesthesia are common methods applied in order to reduce pain and discomfort in patients. All of these methods are able to reduce pain through their affects on neuron fibers. Conclusion: It seems that all common approaches can result in some amount of pain reduction. Using a combination of these methods during injections, practitioners can successfully reduce the pain of injection.

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Section: Local Anesthesiamentioning

confidence: 99%

“…Skin refrigerants are cost‐effective in comparison with local anesthetics but ice is cheaper . As the mechanism of action for ice is the same, it may be preferred but the possibility of uneven anesthesia and cold burns must be considered…”

Section: Vapocoolant Anesthesiamentioning

confidence: 99%

A mini review on the common methods of pain reduction before filler and botulinum toxin injection

Fallahi

Keyhan

Zandian

et al. 2019

J of Cosmetic Dermatology

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“…Alkalinized lidocaine bladder instillations are used effectively in the management of pain in patients with interstitial cystitis and bladder pain syndrome (BPS) 8 . However, a previous study found no statistically significant difference in reported pain with the use of lidocaine gel versus alkalinized lidocaine instillation before BoNTA injection 4 …”

Section: Introductionmentioning

confidence: 99%

“…8 However, a previous study found no statistically significant difference in reported pain with the use of lidocaine gel versus alkalinized lidocaine instillation before BoNTA injection. 4 There are no published randomized controlled trials comparing the effectiveness and morbidity of alkalinized versus nonalkalinized lidocaine liquid-only solutions for management of BoNTA injection pain. Therefore, our study aims to assess the difference in anesthetic effectiveness of intravesical instillation of alkalinized lidocaine versus lidocaine-only solutions before BoNTA injection.…”

Section: Introductionmentioning

confidence: 99%

“…The procedure may be performed under general anesthesia/sedation, spinal block, or local anesthesia. For the latter, the anesthetic protocols vary between departments and lack standardization—both lidocaine and other drugs have been used in different concentrations, volume instilled, and formulations (liquid, gel or a combination of both) 2–4 . A recent study regarding pain during BoNTA injection tried the administration of opioid and belladonna suppository during the procedure, with nonsignificant results 5 .…”

Section: Introductionmentioning

confidence: 99%

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Alkalinized lidocaine solution as a first‐line local anesthesia protocol for intradetrusor injection of onabotulinum toxin A: Results from a double‐blinded randomized controlled trial

Silva

Ponte

Lopes

et al. 2020

Neurourology and Urodynamics

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Aims: Local anesthesia protocols for intradetrusor onabotulinum toxin A (BoNTA) injection lack standardization. We aimed to determine if an alkalinized lidocaine solution is more effective than lidocaine only. Methods: Patients of both genders aged 18 or above enlisted for intradetrusor BoNTA injection (idiopathic, neurogenic, and bladder pain syndrome) were included in a double-blinded randomized controlled trial after obtaining their informed consent. All participants filled a bladder diary and a urine culture was performed. Subjects were randomized 1:1 to Protocol A (20 ml 2% lidocaine + 10 ml 8.4% sodium bicarbonate) or Protocol B (20 ml 2% lidocaine + 10 ml 0.9% saline solution). A Numeric Rating Scale (0-10) was used to assess the level of pain immediately after the procedure (primary endpoint). Secondary endpoints included pain after 1 h, urinary tract infection, acute urinary retention, and hematuria related to the procedure. Results: A total of 116 patients were randomized. Baseline characteristics (age, sex, indication, and bladder diary parameters) of patients in Group A and B were similar. Pain scores at the end of the procedure were significantly lower with the alkalinized solution (Protocol A and B, respectively, 2.37 ± 0.31 vs. 4.44 ± 0.36, p < .01). No differences were observed 1 h after treatment (Protocol A and B, respectively, 0.54 ± 0.17 vs. 0.69 ± 0.19, p = .487). The only adverse event reported was mild-to-moderate self-limited hematuria in 15.4% of patients. Conclusions: The use of an alkalinized lidocaine solution has proven to be significantly superior to lidocaine only as local anesthesia before intradetrusor BoNTA injection, suggesting that this may be considered a first-line option.

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Interventions to improve tolerability of local anesthetic intradetrusor Botulinum toxin injections: A systematic review

Walker

Macpherson

Tasleem

et al. 2022

Neurourology and Urodynamics

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Introduction Intradetrusor BotulinumtoxinA (BTA) injections are recommended for patients with overactive bladder (OAB) refractory to lifestyle changes and medical intervention. It is preferable to perform injections using a flexible cystoscope under local anesthetic (LA) rather than under spinal or general anesthetic owing to the associated anesthetic risks, increased costs, and need for repeated inpatient admission. Injections under LA can be difficult to tolerate for some patients. This review aims to assess interventions that may improve the tolerability of intradetrusor BTA injections under LA. Methods A systematic review was performed using Ovid of Embase + Embase classic and MEDLINE® ALL in November 2021. Articles were included if they reported objectively measured pain scores during LA intradetrusor BTA injections for refractory OAB. The risk of bias was assessed using Cochrane risk of bias tools. Meta‐analysis was not performed owing to the heterogeneity of outcome measures. Results Ten studies were included in this review with a total of 429 participants. The review identified alkalinized lidocaine, electromotive drug administration (EMDA), opiate suppositories, lidocaine bladder instillations, number of injections, and dose of BTA as interventions aimed at improving tolerability. Conclusion EMDA of intravesical alkalinized lidocaine, intravesical, alkalinized lidocaine without EMDA, and a reduction in the number of injection site were all associated with improvements in patient tolerability during LA BTA injections. Further research should address which subgroups of patients find the procedure most painful and would benefit most from these interventions.

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Alkalinized lidocaine versus lidocaine gel as local anesthesia prior to intra‐vesical botulinum toxin (BoNTA) injections: A prospective, single center, randomized, double‐blind, parallel group trial of efficacy and morbidity

Cited by 9 publications

References 8 publications

A mini review on the common methods of pain reduction before filler and botulinum toxin injection

A mini review on the common methods of pain reduction before filler and botulinum toxin injection

Alkalinized lidocaine solution as a first‐line local anesthesia protocol for intradetrusor injection of onabotulinum toxin A: Results from a double‐blinded randomized controlled trial

Interventions to improve tolerability of local anesthetic intradetrusor Botulinum toxin injections: A systematic review

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