The comparison of lidocaine gel and methoxyflurane effects in relieving pain during cystoscopy

Flexible cystoscopy is an easy and safe procedure for diagnosing and following in patients with lower urinary tract signs, hematuria and bladder cancer; and is one of the most common procedure in the outpatient urologic clinics. The pain and signs after flexible cystoscopy are less than rigid cystoscopy. Some patients; specially, at the entrance of scope complain from pain and discomfort; although flexible cystoscopy can be tolerated well. Many options are available to the decrease postoperative cystoscopy pain. In this study we proceeded to the comparison of lidocaine gel and methoxyflurane effects in relieving pain during cystoscopy.
After obtaining informed and written consent sixty patients between 20 and 55 years undergoing a cystoscopy procedure enrolled in this interventional study and were assigned to receive methoxyflurane or lidocaine 2% gel in a non-blind manner. Patients were randomly allocated into two groups, one inhaled 8-10 breath of methoxyflurane before cystoscopy entrance and the other received lidocaine 2% gel 15 minutes before procedure. All subjects were evaluated and compared regarding heart rate, blood pressure, oxygen saturation and pain (utilizing numerical analog scale, from 0-100), before entrance, at the time of drug administration, just at the instrument insertion, during bladder examination, end of procedure and 15 minutes after operation. Pain score more than 30 (based on NAS), treated with alfentanyl 10 µ/kg. Total dosage of alfentanyl between two groups were compared. We used Penthrox inhaler for administration of methoxyflurane with activated charcoal scavenging chamber. (methoxyflurane concentration 0.5-0.7% ). For each patient we used maximum one vial (3cc) without oxygen. After two weeks; BUN, CR, SGOT, SGPT and alkaline phosphatase were measured.
The numerical analog scale for cystoscopy (P Methoxyflurane is an effective analgesic for rigid cystoscopy related pain in men under 55 years old which had opium sparing effect during scope insertion and intravesical viewing.