Intra-bladder Alkalized Lidocaine in Interstitial Cystitis – Popular – Easy Preparation Technique

Mixing Lidocaine and 8.4% sodium bicarbonate to ph 8 can be a puzzler and difficult given the propensity of lidocaine to precipitate at neutral ph’s. Putting in spinal lidocaine (5% lidocaine in 5% dextrose) first and then an equal volume sterile 8.4% bicoarbonate made it easy.

ABSORPTION OF ALKALIZED INTRAVESICAL LIDOCAINE IN NORMAL AND INFLAMED BLADDERS: A SIMPLE METHOD FOR IMPROVING BLADDER ANESTHESIA
RICHARD HENRY, LINDSEY PATTERSON, NICOLE AVERY, ROBERT TANZOLA, DEBBIE TOD,
DUNCAN HUNTER, J. CURTIS NICKEL AND ALVARO MORALES
THE JOURNAL OF UROLOGY 165, 1900–1903, June 2001

• “10 ml. 2% lidocaine gel into the urethra and after 5 minutes the bladder was catheterized with a 10Fr catheter and post-void residual urine was drained.” – It might be better to put gel in sterile urine container, add equal amount of sterile 8.4% bicarbonate mix, and use that as unbuffered lidoane has not been shown to help much initially.
• 5 mg/kg lidocaine was used – which would come to 400 mg lidocaine 5% (8 mls); another article found 200 mg was sufficient (4 mls 5%).
• 10 mls bicarbonate 8.4% for 400 mg (and I presume 5 mls for 200 mg)
• administered sequentially to prevent precipitation of the lidocaine in the syringe or urinary catheter – I presume lidocaine first, then bicarbonate
• held in for 1 hour
• treatments on 2 consequetive days – pain had dropped from 6 to 4/10 prior to second infusion and probably more subsequently

Comment:
I make up 5% lidocaine plain – even mix with bicarb gives good alkalination – needs to be done by patient at home off and on for sustained effects