Comparison of lignocaine and water-based lubricating gels for female urethral catheterization: A randomized controlled trial

Objectives: It is standard practice to use lignocaine gel during male urethral catheterization. However, it is commonly believed that topical anaesthetic confers no benefit during female catheterization hence lubricating gel alone is more commonly used. The present study aimed to determine whether lignocaine gel decreased pain compared with water-based lubricating gel for female urethral catheterization in the ED. Methods: This randomized double-blinded study was carried out at two Sydney hospitals - an urban district inner western hospital and a south-western major trauma centre. A convenience sample of 62 alert, cooperative adult female ED patients provided written informed consent. The indications for, and technique of catheterization, were at the discretion of the clinical staff. Pre- and immediate post-procedure pain was scored by the patient on a 100 mm Visual Analogue Scale (VAS). The primary outcome was the difference in VAS scores (post- minus pre-procedure) in millimetres. Values for each group were expressed as medians and interquartile ranges, statistical significance determined using the Mann-Whitney U-test. Results: The groups were well matched for age, indication for catheterization, pre-procedural pain score, catheter size and the number of catheterization attempts. Patients receiving lignocaine gel had a significantly lower median procedural pain score than patients receiving lubricating gel (6 mm vs 33 mm, P= 0.007). Conclusions: Lignocaine gel substantially reduces the procedural pain of female urethral catheterization by comparison with use of a water-based lubricating gel.