Comparison of Local Anesthetic Efficacy of Lidocaine Gel and Lidocaine Gel-Intramuscular Diclofenac Combination in Patients Undergoing Flexible Cystoscopy

Objective: In this study, we aimed to investigate the effects of 2% lidocaine gel only and 2% lidocaine gel-diclofenac combination on pain in male patients undergoing flexible cystoscopy. Methods: The records of male patients who underwent flexible cystoscopy for lower urinary system symptoms and bladder tumor contol cystoscopy between April 2016, and April 2017, were reviewed. Patients with active urinary infection, urethral stricture, additional procedures during cystoscopy like biopsy, catheter withdrawal, or insertion, and sensory neurological defects were excluded from the study. Patients were divided into two groups according to the analgesic used. Overall, 116 patients in Group I were treated with 2% lidocaine gel, and patients in Group II were treated with 2% lidocaine gel and intramuscular diclofenac. In the gel group, 10 cc of 2% lidocaine gel was instilled into the urethra 15 min before the procedure and immediately before the procedure. In the other group, 75 mg diclofenac was intramuscularly administered 30 min before the 2% lidocaine gel instillation. All operations were performed by the same urologist. VAS scores were filled after the procedure, and the groups were compared. Results: The mean age of the patients was 61±13.1 years in Group I and 59±13.2 years in Group II (p=0.060). The mean duration of the procedure was 341±427 in Group I and 342±51.1 in Group II (p=0.586). There was a statistically significant difference between the groups in pain scores (group I: 6.1±2.5; group II: 4.3±1.7; p<0.001). Conclusion: Intravenous administration of diclofenac, which was performed 30 min before the use of 2% lidocaine gel in males undergoing flexible cystoscopy, provides more effective analgesia than urethral gel alone.