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- -,y THE Jomm.u. oF URoLOGY Vol. 62, No. 6, December 1949 Printed in U.S.A. USE IN THE FEMALE XYLOCAINE: A NEW TOPICAL ANESTHETIC IN URQLOGY1 L C. PRICE "J,T:g, J. S. HAINES s. c. AND HARRY GRABSTALD. · From United States Marine Hospital, Baltimore, Md . .eck thoroughly the urethra eatment. We have customunds available were of the :sary for each case. ~. 26 and 28F, could be inlbs sufficiently far apart to .d give us one . small ' con.dily available· and which important test. months and find it very • the urologist's armamen. urethral strictures which : technique advocated by t of the cases. ·,, Several months ago the urology service at this hospital began to investigate a new anesthetic drug. This new drug called Xylocaine (diethylamino-2:6 diethylacetanalide) was first described by Lofgren and Lundquist of Sweden and its pharmacologica.l properties were studied by Goldberg, who compared it with procaine and tet:rocaine as to toxicity; action on blood pressure, anesthetic qualities, including its use as a topical anesthetic, and local irritant action. He concluded that Xylocaine showed high degrees of anesthetic potency both for surface and infiltration purposes and that it displayed a con;tbination of phar· macological properties which strongly urged its us~ for clinical purposes. ,Of the many qualities desirable in an anesthetic, including low toxicity and effective interruption of painful st:iilluli, rapidity of action is especially important to the urologist who would prefer to be able to do cystoscopy without having to wait for long periods of time, while an anesthetic agent is taking effect. We . believe that Xylocaine has these favorable attributes. We have used Xylocaine in a 2 per cent solution as a topical anesthetic for transurethral procedures varying from mere passage of sounds to cystoscopy with extensive fulguration o{bladder papillomas. Our results have been highly satisfactory and we have noted no untoward reactions. Approximately 10 cc are used for each cystoscopy except in .females in whom Xylcicaine soaked applicator sticks have been successfully used. It is extremely difficult to evaluate an anesthetic agent in cystoscopy wherein so much depends upon subjective differences as well as upon the technique and .skill of the operator. In our series of 250 cases, we have made a special point of including those patients who had had previous cystoscopy either at this hospital or elsewhere when Xylocaine was not used.· Almost without exception, these. patients have expressed a definite preference for the procedure in which Xylocaine was used. In many instances the same operator had occasion to examine these patients with and without the benefit of Xylocaine and the results were rather dec:lsiv~ in favor of this agent. Several cases in our series are worthy of mention. One 75 year old physician who had had recurrent bladder papillomas fulglirated at regular intervals under spinal anesthesia entered the hospital for treatment and refused spinal on this occasion. Highly satisfactory anesthesia was obtained using Xylocaine and approximately 15 bladder papillomas were fulgurated successfully. Two veterans who had suffered straddle injuries and ruptured urethras during the war have been coming to this hospital at regular intervals for urethraldilatations for several years. These men have both reported a definite difference and imp~ove ment following use of Xylocaine.. • The Xylocaine used in this study was furnished by Mr. Erik Bjaringer of the Astra Pharmaceutical Products. · 901 902 J. S. HAINES AND HARRY GRABSTALD Without exception definite subjective differences have been noted in r:ln''"'·'~ whom cystoscopy is done with Xylocaine on one occasion and with other'·u,JtJl•~~:~.r anesthetics on others. :'.~., .. ~. · Allion, G. and Robbins, M. A. Pri Several months ago un\ler the Section titled Queries and Minor Notes .in'hthe. ~ : An unusual complication . of Journal of the American Medical Association a physidan reported on the use:'of . . ·urethral prostatic resectio~, 3~8 "Zylcaine" in local anesthesia. This product is stated\ "to contain in each cc p~o:~., . Adams, J: R., see P. Nowhn, Jt caine base, 0.075 gm.; Butyl aminobenzoate, 0.3 gm.; and benzyl alcohol ·oi25 .. Adrenal, .medulla, pheochromocytom . . ' _. new growths, corte.x, 639 . gm., dissolved in peanut oil." This material is a long lasting anesthetic whick new growths, phechromocytoma,! has apparently produced· some local untoward reactions. This agent is not. the:: Allen, H. N., see G. Carroll, jt. aut} · one· described in this paper. The similarities in names justifies this brief comme~t~ ~>:: Alyea, E. p. and Rundles! R. V\ T· •• "- . marrow studies in carcmoma 1 tate;332 . Amberson, J. B., see J. K. Lattr auth. . American Cystoscope Makers, Inc resectoscope, 381 Vest· cystoscope for dilatation P 378 . American Urological ASsociation, N land Section, fall meeting, 790 New York Section, program of 638 ' North Central Section, program ing, 400 Northeastern Section, program ing, 265 present organization, 799 presidential address·1949, 799 South Central Section, program ing, 402 · Anesthesia, local, !or transureth: tion, 231 . . Anesthetic, urethral, intracame 89 xylocaine, 901 Anomaly, see various organs and > Arcadi, J. A. and Farman, F. Exi studies and clinical aspects circulation, 756 . Arduino, L. J., see E. Baron,_ it.:. Arnkoff, M., see F. E, RuboVIts,: Ascites, 30 . . Aureomycin, urinary tract mfec 594 Aycock, L. Medical managemeJ mature ejaculation, 361 Bailey, M. K., Fort, C. A. and H! Papillary carcinoma of urete der arising after nephrectom: of kidney pelvis, 44