Efficiency of intracavitary levobupivacaine infusion for pain management during cystoscopic procedures: A randomised study

Abstract

Aim: This study evaluated the effect of intracavitary levobupivacaine infusion diluted with locally applied isotonic solution for pain control in cystoscopy.Methods: Included in this study are 100 patients who had previously undergone transurethral tumour resection for bladder tumour and were followed up by cystoscopy. The patients were randomised into five groups (n = 20). In the first, second, third, and fourth groups, 4, 6, 8, and 10 mL of levobupivacaine HCl (5.0 mg/mL) were mixed with 26, 24, 22, and 20 mL of isotonic solution, respectively. Hence, the total mixture was 30 mL for each group. The fifth group was the control group. In this group, the standard method commonly used in most clinics was utilised. That is, a gel containing Cathejell-2% lidocaine (25 mg lidocaine) was applied for local analgesia. Cystoscopic interventions were performed with a 17.5 Fr rigid cystoscope and 0°, 30°, and 70° lens. During cystoscopy and 30 min later, the pain status of patients was assessed using the Visual Analogue Scale (VAS) and patient satisfaction was questioned. Results:The mean VAS score during and after the cystoscopy procedure was significantly lower in the levobupivacaine groups compared with the lidocaine group. In addition, patient satisfaction in the levobupivacaine groups was significantly higher than in the lidocaine group. No drug-related side-effects were observed in all groups. Conclusion:Thus, levobupivacaine is a more effective drug than lidocaine alone to control pain during cystoscopy. The use of levobupivacaine is recommended to prevent possible complications of general anaesthesia by eliminating the need for the aforementioned as well as its cost-saving advantage. What's known• While the cystoscopy procedure is mostly performed with flexible cystoscopes in developed countries for the patient's best comfort, rigid cystoscopy is still mostly preferred in developing or underdeveloped countries due to its cost-effectiveness. Pain management is essential for optimum procedure in local setting.

Transurethral lidocaine (100 mg) bladder irrigation (TULI100) reduces the incidence of catheter related bladder discomfort in transurethral resection of bladder tumors: A randomized, double blind, controlled trial

“…[14][15][16]19 In a study by Pehlivanoglu et al, intracavitary levobupivacaine infusion was observed to significantly lower the VAS score and increase patient satisfaction as compared to locally applied lidocaine gel in patients undergoing cystoscopy post-TURBT surgery. 18 In the current study, no lidocaine related side effects were observed as the administered dose (100 mg) is within the safe range.…”

“…A second possible mechanism for CRBD is detrusor muscle contraction leading to elevated prostaglandin (PG) synthesis. 12,18 By inhibiting PG synthesis and cycloxegenase-2 (COX-2), paracetamol can reduce the intensity and occurrence of CRBD. Local anesthetics are reversible inhibitors of nerve conduction.…”

“…Intravenous lidocaine has been used for various types of surgeries for its anti‐muscarinic, anti‐inflammatory and anti‐hyperalgesic effects and has been found to reduce postoperative opioid consumption and improve perioperative pain control 14–16,19 . In a study by Pehlivanoglu et al., intracavitary levobupivacaine infusion was observed to significantly lower the VAS score and increase patient satisfaction as compared to locally applied lidocaine gel in patients undergoing cystoscopy post‐TURBT surgery 18 . In the current study, no lidocaine related side effects were observed as the administered dose (100 mg) is within the safe range.…”