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

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

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.

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.

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.

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.