Intraureteral lidocaine for ureteral stent symptoms post-ureteroscopy: A randomized, phase 2, placebo-controlled trial

Abstract

Introduction: Ureteral stent and ureteral manipulation-related pain is a significant complication for patients undergoing ureteroscopy. Herein, we report a phase 2, randomized trial to assess efficacy of direct instillation of intraureteral lidocaine in reducing postoperative pain and ureteral stent symptoms. Methods: We performed a randomized, double-blinded trial of patients undergoing elective ureteroscopy for ureteral calculi. Patients were randomized to direct instillation of 2% lidocaine plus bicarbonate, or to normal saline as control. The primary outcome of interest was early postoperative pain scores. Patients completed10-point visual analog pain scale at one-hour, two-hour, four-hour, 24-hours, four-and seven-day time points. Other outcome measurements collected included a medication diary and voiding questionnaire. Results: A total of 41 patients were randomized in the study. Mean flank pain scores at one hour were 2.2 (±2.9) vs.1.9 (±2.4) in the intervention and placebo group, respectively (p=0.84). There was no significant difference at any time point between the intervention and placebo groups in patient-reported pain scores. Patients reported lower dysuria scores at all time points in the lidocaine group, however, none reached statistical significance. There was no difference in complication rates or adverse effects between groups. Conclusions: In this randomized, phase 2 study, direct instillation of lidocaine into the ureter did not appear to significantly improve pain or voiding symptoms following stented ureteroscopy.

Safety and efficacy of total intraluminal topical anaesthesia for ureteroscopy. Is success worth the pain?

“…Although ureteroscopy has been conventionally performed under GA or spinal or under conscious sedation, the procedure, for lower ureteral calculi, has also been described using only 2% lignocaine jelly topically in the urethra 14 and bladder. Conceptually, the benefit of extrapolating this topical anaesthesia, from the bladder into the ureter including the PCS, has been studied by Roberts et al 3 for relief of post-Ureterorenoscopy (URS) stent-related pain. The same has not been studied with respect to performing ureteroscopy.…”

“…Adverse effects such as postdural puncture headaches occur in 0.1%e17.3% of patients, delaying convalescence. 2 The present study was aimed at finding the safety and efficacy of performing ureteroscopy and laser lithotripsy, using alkalinised local anaesthetic solution 3,4 topically, in the entire accessible urinary tract. The perioperative analgesia was provided by a single intramuscular Non Steroidal Anti Inflammatory Drug (NSAID).…”

Strategies for optimizing pain management after ureteroscopy

“…Topical anesthetics have also been shown to potentially reduce pain. In a 2017 randomized study of intra-ureteral lidocaine, Roberts et al found that the direct instillation of lidocaine into the ureter did not significantly improve pain symptoms after URS ( 11 ). Overall, studies evaluating interventions to impact intra-operative analgesic requirements are limited and the impact on post-operative pain remains unclear.…”