İntraüretral prilokain fleksibl sistoskopi yapılan erkek hastalarda etkili anestezi sağlar: Prospektif randomize klinik çalışma

Intraurethral prilocaine provides efficient anesthesia during flexible cystoscopy in male patients: A prospective randomized clinical study

Özet

Amaç: Sistoskopi üroloji pratiğinde en sık yapılan girişimlerden biridir. Gelişen teknolojiyle beraber fleksibl aletlerin kullanımı artmıştır. Böylece işlemler daha konforlu ve daha az ağrılı hale gelmiştir. Fleksibl sistoskopide uygulanan lokal anestezinin süresi, lokal anestezik madde miktarı ve şekli ile ilgili net bir fikir birliği yoktur. Bu çalışmanın amacı; fleksibl sistoskopi yapılan erkek hastalarda hissedilen ağrının kontrolünde lokal anestezik ajan olan prilokain kullanımının lubrikan etkisi de olan lidokain jel kullanımına üstün olup olmadığını ortaya koymaktır. Yöntemler: Çalışmaya Ocak 2012 - Aralık 2012 tarihleri arasında fleksibl sistoskopi yapılan 70 erkek hasta dahil edildi. Çalışmayla ilgili bilgilendirme ve yazılı onam alındıktan sonra hastalar 2 gruba ayrıldı. Grup 1deki 34 hastaya, %2lik 10 mL lidokain jel lubrikan etki açısından fleksibl sistoskop üzerine sürülerek sistoskopi işlemi hemen yapıldı. Grup 2deki 36 hastaya, 20 mL %2lik prilokain üretral yoldan verildi ve 15 dakika sonra sistoskopi işlemi gerçekleştirildi. Sistoskopiden hemen sonra vizuel analog ağrı skalası (VAS) sorgulaması yapılarak kaydedildi. Bulgular: Gruplar arasında yaş ile ilgili istatistiksel fark izlenmezken (p=0,218), sistoskopi süreleri açısından anlamlı fark vardı (p=0,027) ve işlem süresi grup Ide daha uzundu. Grup Ide VAS skorları anlamlı derecede daha yüksekti (p=0,001). Daha sonra her iki grup sistoskopi endikasyonlarına göre 2 alt gruba ayrıldı. Her iki grupta da terapötik amaçlı sistoskopi yapılan hastaların VAS skoru diagnostik sistoskopi yapılanlara göre istatistiksel olarak anlamlı fark göstermekteydi (p=0,001; p=0,009). Sonuç: Çalışmamızda üretraya instile edilen ve sistoskopi öncesi üretrada 15 dakika bekletilen prilokainin özellikle genç erkeklerde konforlu bir lokal anestezik etki gösterdiğini gözlemledik.

Abstract

Objective: Cystoscopy is one of the most common interventions in urological practice. Before the introduction of flexible cystoscopy, many patients underwent rigid cystoscopy with great discomfort. With the technological developments, flexible instruments have been more popular in cystoscopic procedures for performing interventions with less pain and less discomfort. There is still no consensus about the amount, type and retention time of the local anesthetics in flexible cystoscopy, and various studies have been performed to assess these parameters related to local anesthetics. The purpose of this prospective randomized study is to compare the efficacy of prilocaine, a local anesthetic agent, on the control of perception of pain in male patients during flexible cystoscopy and to determine whether it is superior to lidocaine gel, which also has a lubricant effect. Methods: A total of 70 male patients who underwent flexible cystoscopy between January 2012 and December 2012 enrolled in the study. Patients who had active urinary tract infection, urethral stenosis, and neurologic disease like spinal cord injury and needed additional procedures like bladder biopsy were excluded from the study. Patients were randomized into two groups and written consent was obtained from each patient. There were 34 patients in group 1, Thirty six patients in group 2 and all interventions were performed by the same urologist using a 15.5 F flexible cystoscope. In group 1, 10 mL 2% lidocaine gel was spread on the cystoscope and cystoscopy was performed immediately. In group 2 patients, 20 mL 2% prilocaine was applied intraurethrally followed by application of a penile clamp across the mid penis, and the procedure was performed after 15 minutes. At the end of the procedure, patients were questioned regarding pain perception using a visual analogue scale (VAS), by the appropriate physician. Results: Seventy male patients were recruited in the study. Forty three (61.4%) and 27 (38.6%) patients had cystoscopic examinations for diagnostic and therapeutic purposes(to remove double j stent), respectively. Although in our study no statistical difference was observed between the groups related to the mean ages (p=0.218), there was a significant difference in duration of cystoscopy (p=0.027), which was longer in group 1 than in group 2. Besides, VAS scores were also significantly higher in group 1 (p=0.001). Both groups were then divided into two subgroups according to the indication for cystoscopy. There was a statistical difference regarding the VAS score between the therapeutic and diagnostic groups in both groups (p=0.001, p=0.009). Conclusion: In our study, we observed that the effect of prilocaine instilled into the urethra and maintained there for 15 minutes before cystoscopy led to a comfortable intervention, especially in younger men.