A comparative study of the effectiveness of cooled versus room temperature lignocaine gel for relieving pain during optical internal urethrotomy

Abstract

Introduction: Optical Internal urethrotomy (OIU) is conventionally performed under regional anaesthesia. Various studies have shown that it can be done under local anaesthesia. However, regional anaesthesia provides better pain control than local anaesthesia. Cold lignocaine gel instilled intraurethrally has been proven to provide superior analgesia for cystoscopies compared to room temperature lignocaine gel. We aimed to compare the effectiveness of cooled versus room temperature lignocaine gel in OIU. Materials and methods: A total of 138 patients scheduled for OIU were included. After applying exclusion criteria, 108 patients were randomised into two groups: Group A (room-temperature lignocaine) and Group B (lignocaine cooled to 4℃). OIU was performed, and the Visual Analogue Scale (VAS) score was compared between both the groups during incision and 20 min from the start of the procedure. Results: Age, stricture length and duration of procedure were comparable between the groups. The VAS score was significantly lower in Group B (2.54± 0.99) compared to Group A (4.19 ± 0.84). Even after 20 min from the start of the procedure, the VAS score was significantly lower in the cooled lignocaine gel group (1.32 ± 0.65) than in the room temperature lignocaine gel group (2.27 ± 0.74). No additional complications were observed with the use of cooled lignocaine gel. Conclusion: Cooled lignocaine gel offers superior pain control for OIU without additional complications. Its use can make OIU a less painful, more cost-effective procedure with short hospital stay, especially in resource-limited setting. These findings should be validated in larger multicentre trials that incorporate formal Patient-Reported Outcome Measures (PROMs) to effectively evaluate patient satisfaction.