A controlled, randomised trial comparing single to multiple application lidocaine analgesia in paediatric patients undergoing urethral catheterisation procedures.

Aims And Objectives: The aim of this study was to evaluate if discomfort levels are statistically significant when two different topical and intraurethral precatheterisation analgesia strategies are used. The primary objective of this research project was to examine methods to decrease pain experienced by paediatric cystogram patients.

Background: Paediatric patients undergoing urinary catheterisations frequently report discomfort. To alleviate catheterisation discomfort in children, some institutions have either used sedation techniques or topical analgesia strategies. Standardisation of topical anaesthetic application prior to paediatric urinary catheterisation has not been demonstrated in the research literature.

Design: A prospective, single-blind, randomised, controlled trial.

Methods: The trial was performed with infants and children aged two months-eight years. The first group received one application of lidocaine five minutes prior to catheterisation. The control group received two applications, spaced five minutes apart prior to catheterisation. The FLACC pain score, as the primary outcome variable, was assessed at the time of the catheterisation. Secondary outcome variables including pre- and postcatheterisation heart rate and parental perception were also measured.

Conclusions: Two hundred children between two months-eight years of age were randomly assigned for study inclusion with 91 patients enrolled into the two application groups and 109 patients into the single application group. No statistically significant differences (p = 0.779) in the mean FLACC pain score at the time of the catheterisation between the intervention (single application) group (mean = 3.30) and the control (two application) group (mean = 3.39), heart rate or parental perceptions were observed.

Relevance To Clinical Practice: Topical and intraurethral lidocaine analgesia strategies prior to urinary catheterisation provide an important tool in reducing discomfort for paediatric patients undergoing urinary catheterisation procedures. This study confirms that multiple applications of intraurethral lidocaine gel add little additional benefits in reducing discomfort over single intraurethral application techniques.