Lidocaine gel may not provide substantial advantage over nonanesthetic gel for reducing pain associated with transurethral bladder catheterization in children age <4 years, according to a meta-analysis published in the Annals of Emergency Medicine.
In this study, 2 investigators independently reviewed randomized controlled trials comparing the pain-relieving efficacy of lidocaine gel vs nonanesthetic gel in pediatric patients undergoing transurethral bladder catheterization. A total of 5 studies with 369 patients were included for evaluation.
Pain assessment scales used in these studies included the Oucher pain scale; Face, Legs, Activity, Cry, Consolability pain scale; and Modified Behavioral Pain Scale.
A pooled analysis indicated that the use of lidocaine gel was nonsuperior to nonanesthetic gel for relieving pain in children <4 years old (standard mean difference [SMD], 0.01; 95% CI, -0.22 to 0.24). Results from one study indicated that pediatric patients >4 years old may experience greater pain improvement with lidocaine gel vs a chlorhexidine gel when undergoing transurethral bladder catheterization (SMD, -1.84; 95% CI, -2.92 to -0.75).
The studies included in this meta-analysis varied in pain scales used, lidocaine contact duration, and catheterization technique, which may limit the findings. In addition, only 1 study evaluated patients >4 years old, thus limiting the findings of this analysis to younger children.
Greater emphasis on developing effective pain management strategies for children undergoing transurethral bladder catheterization is needed considering many “parents often refuse the procedure because of perceived pain.”
Long B, April MD. Does lidocaine gel decrease procedural pain for pediatric urethral catheterization [published online February 13, 2018]? Ann Emerg Med. doi: 10.1016/j.annemergmed.2018.01.019