Intraurethral Instillation of Ketamine and Lidocaine versus Lidocaine for Male Rigid Cystoscopy: A Prospective Randomized Controlled Trial.

Abstract

Background Male rigid cystoscopy is one of the most common outpatient procedures in urology because of it lower cost, better optical area and better orientation compared with flexible devices. However, performing rigid cystoscopy is not only painful but equally apprehensive in awake male patients. Objective The study was conducted to evaluate the efficacy of lidocaine gel and ketamine solution together compared with lidocaine gel alone during male rigid cystoscopy. Method A total of 76 male patients who visited the hospital for rigid cystoscopy were randomized into two groups before undergoing cystoscopy. The experimental group received 15 ml lidocaine with 2 ml (100 mg) Ketamine solution while the control group received 15 ml lidocaine gel with 2 ml Normal saline. Patient's heart rate and mean arterial pressure were recorded in five minutes interval till twenty minutes after completion of the procedure. The level of pain perception of all the patients was measured with Visual analogue scale (VAS) score, at the beginning, during and after cystoscopy. Independent sample t-test was used to compare outcome measures and p value of < 0.05 was considered statistically significant. Result Out of the total 70 patients analyzed at the end of study with 35 patients in each group, the VAS score in each stage were lower in lidocaine plus ketamine group compared to lidocaine gel alone. The difference was significant at the commencement and middle of the procedure (p < 0.05). Conclusion Intraurethral instillation of ketamine and lidocaine is more effective in reducing mean pain score during cystoscopy as compared to lidocaine alone.