Bladder and urethral anaesthesia with electromotive drug administration (EMDA): a technique for invasive endoscopic procedures

To assess the efficacy of the electromotive administration of lignocaine and adrenalin as local anaesthesia (EMDA/LA) for invasive lower urinary tract procedures. Electric current generators, catheters and electrodes were designed and fabricated, using defined electrochemical principles, to carry out EMDA/LA of the bladder and prostatic urethra of 91 patients who underwent 27 bladder-mapping biopsies, 62 transurethral resections (TURs) of bladder tumours, 21 transurethral incisions on the prostate or bladder neck incisions, 12 TURs of the prostate (122 operations in total) and nine miscellaneous interventions, all using rigid instruments. Resections were performed using electrocautery. Most patients, while minimally sedated and fully conscious, completed an assessment of EMDA/LA using a simple pain scale. In five of the 122 procedures, the pain was described as intolerable, six were recorded as painful but tolerable and the remaining 111 procedures were recorded as having minimal to no discomfort only. Side-effects were few, there was no clinical evidence of lignocaine toxicity and serial serum lignocaine levels measured in four patients were innocuous. EMDA/LA provides safe, effective anaesthesia for most invasive endoscopic procedures in the lower urinary tract.