Supplemental Lidocaine Patches Prior to Percutaneous Nerve Evaluation, a Randomized Trial.

Abstract

Importance: Improving patient comfort during percutaneous nerve evaluation (PNE), a trial procedure for sacral neuromodulation, is essential.

Objective: The aim of the study was to determine whether the use of a lidocaine patch (LP) prior to PNE procedure improves the pain associated with PNE.

Study design: This double-masked, randomized controlled trial compared a 4% LP to placebo patch (PP) immediately prior to PNE. Female patients ≥18 years of age were included if they were undergoing an office PNE, performed bilaterally and without fluoroscopy, for any indication. Either a lidocaine or placebo patch was placed over the sacrum 30 minutes prior to PNE. Additional local anesthesia with 2% lidocaine without epinephrine was administered per surgeon discretion. All patients received some volume of injectable lidocaine with their procedures. Secondary outcomes included volume of injectable lidocaine used, progression to a permanent implant, amplitude of perineal sensation, and patient satisfaction.

Results: Thirty-nine women were enrolled, with 20 receiving LP and 19 patients receiving PP. Lower 100-mm visual analog scale pain score was seen in the LP group (45 ± 17 with LP vs 61 ± 21 with PP, P = 0.018). This difference was statistically and clinically significantly different between groups. The total injectable lidocaine, patient satisfaction, and progression to permanent implant were similar between groups.

Conclusions: Patients experienced clinically and statistically significantly less pain at the time of PNE with a preprocedural LP when compared to placebo, despite similar use of local anesthetic. Satisfaction rates were high among all patients.