Intravesical anesthesia for bladder tissue biopsies. Comparison of two methods.

PURPOSE To estimate the level of analgesia which can be obtained with simple intravesical instillation of ropivacaine in comparison to the combination of both instillation and subepithelial injection of the same agent. MATERIALS AND METHODS Fifty-two patients were randomized in order that half (26) of them received simple intravesical instillation of ropivacaine (100 mL solution of ropivacaine in a concentration of 2 mg/mL) (Group A), whereas the other 26 patients received both intravesical instillation and subepithelial injection of 2 mL (4 mg) at the site of biopsy (Group B). In both groups, tissue samples were obtained from urinary bladder (number of biopsies from 3 to 4). The pain during the procedure was estimated by using the Visual Analogue Scale (VAS) which ranged from 0 to 10. RESULTS The entire procedure was integrated with success in 50 out of 52 patients. The VAS score for the Group A ranged from 4 to 6 (mean 5.08), whereas for Group B from 1 to 3 (mean 1.6). (p<0.0001). Higher values of VAS score were recorded in males in both Groups (p<0.05). When complications of this method produced a slight bleeding (hematuria) in 6 patients (2 from group B and 4 from group A), they were treated with oral administration of fluids. Allergic reactions were not recorded. Hospitalization did not exceed 3 hours after the procedure. CONCLUSIONS The analgesic effect that was obtained with the combination of intravesical instillation and subepithelial injection of ropivacaine provides a safe method of anesthesia for transurethral bladder biopsy.