Lidocaine as topical anesthesia for bladder mappings and cold-cup biopsies

We describe the use of lidocaine as a topical anesthetic for 35 patients undergoing random bladder biopsies (bladder mappings) and cold-cup resection of small bladder lesions. Serum lidocaine levels were measured 7 to 10 minutes after instillation of the anesthetic using fluorescent polarization immunoassay. Adequate pain control was noted in 33 of 35 patients (94%), with negligible serum lidocaine levels noted in all 35. One patient had a 2 cm. tumor on the anterior wall of the bladder making resection with topical anesthesia suboptimal and 1 patient required 1 mg. supplemental intravenous midazolam hydrochloride to complete the procedure. We conclude that topical lidocaine is a safe, inexpensive and effective mode of anesthesia for bladder mappings and cold-cup biopsies of small bladder lesions. However, it may be inadequate for lesions large enough to require resection rather than cold-cup biopsy and those at poorly accessible regions of the bladder.