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    Verbal anesthesia: How it’s used in urologic procedures

    ‘Conversational distraction’ offers clinical, efficiency benefits to patients and physicians


    What is verbal anesthesia (aka ‘vocal local’)?

    Verbal anesthesia (VA) is the art of conversational distraction associated with measures to ensure a calming environment. It is commonly but haphazardly used by in-office surgeons of many disciplines, and is poorly described in the literature (Urology 2011; 77:12-6). Generally speaking, well-focused VA draws a patient’s attention away from negative stimuli, thereby reducing pain, anxiety, and stress. In so doing, VA encourages a procedural environment that helps to maintain relaxation, well-being, and comfort, enhancing and expanding the urologist’s in-office procedural armamentarium.

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    Good VA begins with clear preoperative communication. It is important to set patient expectations at the time of scheduling. On the procedure day, an assistant is assigned the role of “verbal anesthetist” for the case and begins to set the tone with calming conversation while rooming the patient. Furthermore, care is taken to ensure that the room temperature is made comfortable (72º-74ºF) and that soothing music is playing (J Endourol 2013; 27:459-62; Urol J 2016; 13:2612-4; J Endourol 2014; 28:739-44).

    Once the patient has disrobed, been properly positioned, prepped, draped (preferably with warm soap), and anesthetized as required, the procedure is undertaken. For many urologic procedures, a surgical blinding screen is advantageous, minimizing anxiety resulting from a patient seeing our large and unfamiliar instruments.

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    As the physician begins to work, the conversation between the verbal anesthetist and the patient is deliberately guided to something entirely unrelated to the procedure (eg, weather, family, hobbies, etc.). Along the way, specific coaching comments from the urologist will occasionally be needed. When such encouragement is offered, very selective phrases are used, such as “You will feel some cold water,” “Breathe slowly and easily,” “Try to wiggle your fingers and toes,” “Here come those noises I told you about,” and “let me know when your bladder feels full.” Stress-inducing phrases are avoided, such as “I’m going to insert the scope now,” “This is going to hurt a little,” “I’m going to fire the gun/device,” or “Hold your breath,” and use of the word “pain,” as it seems intuitive that certain words and phrases actually increase a patient’s anxiety.

    Next: "The more the verbal anesthetist can personalize the conversation, the more likely the patient can be effectively distracted throughout the procedure"


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    • [email protected]
      Good Morning: I'm curious as to whether more urologists are using male nurses in their practice as most urology patients are male. Having a male nurse along with male verbal anesthetists rather than a females for an intimate procedure would lend itself to making many male patients more comfortable as many men, are not comfortable being so intimately exposed in front of a woman other then their wife, but they won't say so because they don't want to be seen as being weak. It's a known fact male patients won't speak up for fear of being seen as weak and being mocked as such by the medical community. Having all males in the treatment room would also lend itself to making it easier for the male verbal anesthetist to strike up and keep a conversation going longer with his male patient whereby better keeping the patient's mind off of what's going on in the room. Verbal anesthesia has potential if it's used in conjunction with asking a patient are they comfortable with female staff being in the room and if not replacing the female staff with male staff. Verbal anesthesia on a male patient who is not comfortable to begin with being so intimately exposed in front of female staff won't mean a hill of beans to the him which in turn won't help his outcome. Regards, Raffie
    • UBM User
      I particularly found this article interesting in that I have been using this method for over 25 years. Although anecdotal, this method was extremely successful. A number of patients commented how the procedure done was not nearly as uncomfortable as they expected. There is no control group, randomization, or longitudinal aspect to this, none the less, it is nice to see an article on my method of additional anesthesia used during my entire career.