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NRI 99-343 – HSR&D Study

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NRI 99-343
Can Lidocaine Reduce Urinary Catheter Pain?
Tina L Keller RN MSN
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, CA
Funding Period: February 2002 - August 2003

BACKGROUND/RATIONALE:
Research indicates that post-operative pain may be detrimental to the recovery of surgical patients (Devine, 1993) and traditionally its management has not been a priority of the health care system. Recently we have witnessed an increasing interest in postoperative pain management.

OBJECTIVE(S):
Preventing pain is a basic philosophical nursing imperative. Our objective is to evaluate whether prophylactic lidocaine jelly applied to the urethra prior to urinary catheterization will decrease genitourinary pain. Subjects will be males with planned surgery (1-6 hours in length) not involving the GU area, which will use short acting anesthetics. Our intent is to study patient catheter pain post-surgically using visual analog pain ratings scales at three different time periods: one hour after arrival in post anesthesia recovery unit, four hours after first assessment, and 12-24 hours after second assessment. Although there is some variance in surgery time and type of surgery, patient catheter pain assessments will be standardized to be at same time frames after surgery has ended.

METHODS:
Research Nurse will insert patient catheters just prior to surgery after they have started anesthesia induction. This is a three arm randomized experimental design with 60 patients in each arm completed (N=250 to control for drop outs). Subjects in the first arm will have 10cc of lidocaine jelly placed in their urethra five minutes prior to catheter insertion. Using the same technique as in arm one, subjects in the second arm will have 10cc of lubricating jelly placed in their urethra. Subjects in arm three will have their foley catheter inserted in the standard manner with lubricating jelly placed on the lower portion of the catheter prior to foley insertion. Patients and study nurse who will record catheter pain assessments will be blinded as to how foley was inserted. Nurse anesthetists will be blind as to whether patient has been assigned to arm one or arm two. Correlations or associations between potential confounding variables and the outcome, as well as significant differences on confounding variables between groups will be examined to help determine the need for statistical control of confounders. It will be difficult to perform stratified randomization in this type of study. Therefore, we will incorporate important confounders in the post hoc analysis. These are age, ethnicity, type of surgery, and presence of indwelling foley catheter at time of pain assessment.

FINDINGS/RESULTS:
The study is ongoing. We have enrolled 232 subjects to date and need 18 more to complete enrollment. No findings or results are available.

IMPACT:
If findings show that lidocaine gel significantly reduces urinary catheter pain or discomfort, this will change our current practice of using plain lubricant for catheter insertion. This study could impact not only VA male patients within this facility, but VA nationally, as well as non-VA male populations requiring urinary catheters.

PUBLICATIONS:
None at this time.


DRA: Acute and Combat-Related Injury
DRE: Prevention
Keywords: Nursing, Pain, Patient outcomes
MeSH Terms: none

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