One study in males found that those who received liquid paraffin lubricant had significantly less pain than those who received lidocaine gel during catheter insertion. The relevant study in the systematic review and one of the randomized controlled trials showed that pain level was significantly reduced when topical analgesics such as prilocaine or ketamine were added to lidocaine gel, compared to lidocaine gel only. Two studies found that measures of urodynamic function were significantly different among those who received lidocaine compared to those received placebo, but results were inconsistent between the studies in terms of which metrics were different. Overall, there was evidence from four studies that compared to patients who received placebo, patients who received anesthetic (lidocaine) had significantly lower pain levels, or no difference in pain levels, both during and following catheter insertion. This report reviewed the evidence from one systematic review with meta-analysis containing one relevant study, and six randomized controlled trials, to assess the clinical effectiveness of local anesthetic in adults undergoing urinary catheterization. The purpose of this report is to summarize the information available about the clinical effectiveness, cost-effectiveness, and guidelines for the use of local anesthesia during urinary catheterization in adults. 4 To address the inconsistency in previous studies, more information is required to determine the extent to which local anesthesia improves outcomes for urinary catheterization. 1, 4 This inconsistency in findings might reflect inconsistency in the way it is used, including varying dosages, urinary instillation versus application to the catheter, and insufficient wait-time for the drug to take effect.

1, 2Īlthough it is common practice in some jurisdictions to use local anesthesia to relieve pain during urinary catheterization, there has been a limited quantity of mixed evidence regarding the extent to which it reduces pain. 1, 12 Manufacturers of several commercial brands warn that individuals with urethral lesions or injury are at risk for potential severe adverse effects due to systemic exposure. 11 In patients with an in-tact urethra, lidocaine hydrochloride gel is generally considered safe for use with few associated adverse effects.

4, 10 There are several commercial products available, with concentrations of lidocaine ranging from 2 to 5% and the required time interval between instillation and catheterization (incubation times) varying from 5 to 25 minutes. 9 A lubricating gel containing local anesthetic, such as lidocaine, may provide additional pain reduction. When catheters are inserted, aqueous lubricants can be used to reduce the risk of pain and discomfort, urethral damage, and procedure-related infection according to national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. 6 Although some individuals do not experience significant pain associated with catheterization, and others note that the level of pain is typically low (e.g., below 30 mm on a visual analog scale where 0 represents “no pain” and 100 represents “most possible pain”), 7, 8 it is important to know the best way to manage catheterization pain for those who experience it. Another international study found catheter related bladder discomfort (CRBD) was experienced in 47% of patients who had catheters inserted during surgical recovery. This represents individuals with long-term indwelling catheters, and does not take into account individuals with catheters for short-term procedures. A report from England detected a catheterization prevalence of 0.141–0.146% in the community, 5 which would represent approximately 50,000 individuals in Canada. 2 – 4 Specific information on the incidence of catheterization and related pain in Canada is limited. 1Ĭatheterization is associated with pain and discomfort.

2 A catheter may be used in a variety of contexts including patients recovering from surgery, or those with acute injuries or chronic illnesses that impair normal bladder function. They can be inserted multiple times each day in a non-medical setting by patients or caregivers, as well as medical professionals. 1 Intermittent (in-and-out) catheters are removed shortly after insertion and bladder clearing. Indwelling catheters remain in place for days to months after placement, and are commonly inserted by medical professionals. Catheter material, duration of placement, diameter, or length can vary depending on the patient and medical purpose. 1 A flexible plastic tube is inserted through the urethra to the bladder, which allows urine to drain freely or allows fluid to be added. Urethral catheterization is a common procedure used in the management and diagnosis of bladder dysfunction.

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