Local Anesthetic for Urinary Catheter Insertion: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Key Message

This report reviewed the evidence from one systematic review with meta-analysis containing one relevant study, and six randomized controlled trials, to assess the clinical effectiveness of local anesthetic in adults undergoing urinary catheterization. Overall, there was evidence from four studies that compared to patients who received placebo, patients who received anesthetic (lidocaine) had significantly lower pain levels, or no difference in pain levels, both during and following catheter insertion. Two studies found that measures of urodynamic function were significantly different among those who received lidocaine compared to those received placebo, but results were inconsistent between the studies in terms of which metrics were different. The relevant study in the systematic review and one of the randomized controlled trials showed that pain level was significantly reduced when topical analgesics such as prilocaine or ketamine were added to lidocaine gel, compared to lidocaine gel only. One study in males found that those who received liquid paraffin lubricant had significantly less pain than those who received lidocaine gel during catheter insertion. The heterogeneity in findings may be due to differences in anesthetic doses; catheter type and size; gel application method; time intervals between instillation, catheterization, and outcome measures; reason for and duration of catheterization; population characteristics including sex and age; types of outcomes recorded; and comparison to placebo, alternative lubricant, or analgesic-augmented lidocaine gel. No economic evaluations or evidence-based guidelines were identified assessing the use of local anesthetic in urinary catheterization.