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Karaaslan M, Olcucuoglu E, Kurtbeyoglu S, Tonyali S, Yilmaz M, Odabas O. Erector spinae plane block prior to extracorporeal shock wave lithotripsy decreases fluoroscopy time and promise a comfortable procedure for renal stones: A prospective randomized study. Actas Urol Esp 2023; 47:566-572. [PMID: 37084807 DOI: 10.1016/j.acuroe.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION AND OBJECTIVES To compare the efficacy of erector spinae plane block (ESPB) and intramuscular (i.m.) diclofenac sodium in regard to pain management and impact on stone-free status in patients undergoing SWL. PATIENTS AND MATERIALS The study included patients who underwent SWL for kidney stones in our institution. The patients were randomly assigned to the ESPB (Group 1: n = 31) and i.m. 75 mg diclofenac sodium (Group 2: n = 30) groups. The demographic data of the patients, fluoroscopy time during SWL, number of need of targeting, total shocks given, voltage, stone free rates (SFR), analgesy method, number of SWL sessions, VAS score, stone location, maximum stone size, stone volume and Hounsfield unit (HU) were also recorded. RESULTS A total of 61 patients were included the study. There was no statistically significant difference between the two groups according to stone size, volume and density, SWL duration, total shocks given, voltage, BMI, stone-free status and stone location. Fluoroscopy time and number of need for stone targeting were significantly lower in group 1 than group 2 (p = 0.002, p = 0.021, respectively). The VAS score was significantly lower for group 1 compared to group 2 (p < 0.001). CONCLUSIONS We observed that the VAS score was lower in the ESPB group compared to i.m. diclofenac sodium group and although it was not statistically significant, we achieved a higher rate of stone-free status in the first session in ESPB group. Most importantly, the patients in the ESPB group were exposed to less fluoroscopy and radiation.
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Affiliation(s)
- M Karaaslan
- Servicio de Urología, Hospital Estatal de Bingol, Bingol, Turkey.
| | - E Olcucuoglu
- Servicio de Urología, Universidad de Ciencias de la Salud, Hospital de la Ciudad de Ankara, Ankara, Turkey
| | - S Kurtbeyoglu
- Servicio de Anestesiología y Reanimación, Universidad de Ciencias de la Salud, Hospital Municipal de Ankara, Ankara, Turkey
| | - S Tonyali
- Facultad de Medicina, Universidad de Estambul, Servicio de Urología, Estambul, Turkey
| | - M Yilmaz
- Servicio de Urología, Centro Médico Universitario de Friburgo, Facultad de Medicina, Friburgo, Germany
| | - O Odabas
- Servicio de Urología, Universidad de Ciencias de la Salud, Hospital de la Ciudad de Ankara, Ankara, Turkey
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Weynants L, Chys B, D'hulst P, Merckx L, Van Besien J, Tailly T. Virtual reality for pain control during shock wave lithotripsy: a randomized controlled study. World J Urol 2023; 41:589-594. [PMID: 36680576 DOI: 10.1007/s00345-023-04280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 12/30/2022] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Although external shock wave lithotripsy (SWL) is an outpatient procedure generally not requiring anesthesia or sedation, patients may experience pain during the procedure. The aim of this study is to evaluate whether a virtual reality device is effective in reducing patient-reported pain during the procedure, consequently leading to exposure to higher energy levels and better clinical outcomes. METHODS Inclusion criteria for SWL were according to the latest EAU guidelines on urolithiasis. Patients were randomized 1:1 in two groups (SWL with VR and SWL without VR). The primary outcome of this randomized, controlled study (RCT) was an overall difference in pain levels determined by VAS-scores. Secondary outcomes were differences in comfort levels, determined by Likert-scale scores, clinical success and total delivered energy. RESULTS Between January 2019 and September 2021, we enrolled 166 patients; 84 were randomized to the control arm and 82 to the VR arm. Patients without VR experienced significantly more pain compared to the VR group (mean VAS-score = 4.94 vs 4.01; p = 0.011). The mean total delivered energy was significantly higher in the VR group compared to the control group (55.2 J vs. 48.8 J; p = 0'037). No significant differences in comfort levels and clinical success were found. CONCLUSION This study supports the use of VR as a method of pain relief during shock wave lithotripsy. Higher energy levels can be achieved during the treatment while comfort levels remained equal; this however did not lead to improved clinical success. REGISTRATION NUMBER AND NAME OF TRIAL REGISTRY Clinicaltrials.gov: NCT05183269. Virtual reality for pain control during extracorporeal shock wave lithotripsy: prospective, comparative, randomized study at a single institution. https://clinicaltrials.gov/ct2/show/NCT05183269?term=shock+wave+lithotripsy&cond=virtual+reality&cntry=BE&draw=2&rank=1 .
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Affiliation(s)
- Laurens Weynants
- Department of Urology, AZ Sint-Lucas Ghent, Groenebriel 1, 9000, Ghent, Belgium. .,Department of Urology, University Hospital Ghent, Ghent, Belgium.
| | - Brecht Chys
- Department of Urology, AZ Sint-Lucas Ghent, Groenebriel 1, 9000, Ghent, Belgium
| | - Pieter D'hulst
- Department of Urology, AZ Sint-Lucas Ghent, Groenebriel 1, 9000, Ghent, Belgium
| | - Luc Merckx
- Department of Urology, AZ Sint-Lucas Ghent, Groenebriel 1, 9000, Ghent, Belgium
| | - Jeroen Van Besien
- Department of Urology, AZ Sint-Lucas Ghent, Groenebriel 1, 9000, Ghent, Belgium
| | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
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Hu W, Yang K, Zhang L, Lu X. Effect of media distraction (audio-visual and music) for pain and anxiety control in patients undergoing shock-wave lithotripsy: A systematic review and meta-analysis. Exp Ther Med 2021; 21:623. [PMID: 33936280 PMCID: PMC8082642 DOI: 10.3892/etm.2021.10055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/20/2021] [Indexed: 12/29/2022] Open
Abstract
Audio-visual (AV) or music distraction may be used to reduce pain during several healthcare procedures. The present manuscript is a systematic review and meta-analysis to assess the effectiveness of media distraction in reducing pain and anxiety in extracorporeal shock wave lithotripsy (ESWL) patients. The PubMed, Embase, Scopus, BioMed Central, Ovoid and CENTRAL (Cochrane Central Register of Controlled Trials) databases were screened for studies assessing the role of media distraction (music/AV media) in reducing pain and anxiety of ESWL patients. Data were summarized using the mean difference (MD) with 95% confidence intervals (CI). A total of 11 randomized controlled trials were included. Pooled analysis indicated a statistically significant difference in pain outcomes with media distraction [mean difference (MD): -1.18; 95% CI: -2.35, -0.01; I2=96.8%)]. Subgroup analysis indicated that both AV media (MD: -2.94; 95% CI: -4.70, -1.17; I2=79.2%) and music (MD: -0.86; 95% CI: -1.37, -0.35; I2=62.5%), led to significant reduction in pain outcomes. Pooled analysis indicated a statistically significant reduction of anxiety scores with the use of media distraction (MD: -3.91; 95% CI: -6.44, -1.38; I2=77.7%). To conclude, the present review suggests that media distraction in the form of AV media or music may be beneficial in reducing the pain and anxiety of patients undergoing ESWL. Evidence is, however, weak considering the small effect size, confidence intervals being close to zero, and instability of the results on sensitivity analysis. In clinical practice, media distraction may be used during ESWL as a nursing intervention, but a clinically important reduction of pain and anxiety may not be expected.
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Affiliation(s)
- Weihua Hu
- Department of Urology, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410000, P.R. China
| | - Ke Yang
- Department of Urology, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410000, P.R. China
| | - Li Zhang
- Department of Urology, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410000, P.R. China
| | - Xu Lu
- Department of Laboratory Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410000, P.R. China
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Eutectic mixture of local anaesthetics for pain reduction during extracorporeal shockwave lithotripsy: A systematic review and meta-analysis. PLoS One 2020; 15:e0237783. [PMID: 33017397 PMCID: PMC7535034 DOI: 10.1371/journal.pone.0237783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/03/2020] [Indexed: 02/05/2023] Open
Abstract
A systematic review and meta-analysis was conducted to explore the effect of a eutectic mixture of local anaesthetics (EMLA) on pain reduction during extracorporeal shockwave lithotripsy (ESWL). PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases (updated March 2020) were searched for randomised controlled trials (RCTs) assessing the effect of EMLA for patients that underwent ESWL. The search strategy and study selection process were managed according to the PRISMA statement. Six RCTs were included in the meta-analysis. Overall, the results indicated that EMLA significantly reduced pain compared to the control group (RR = -2.98, 95% CI = -5.82 to -0.13, P = 0.04) with a heterogeneity of I2 = 57% (P = 0.04). Subgroup analysis showed that EMLA did not significantly reduce pain when the patients took an analgesic premedication (RR = -1.46, 95% CI = -5.89 to 2.98, P = 0.52) with a heterogeneity of I2 = 38% (P = 0.52). Conversely, studies without premedication showed a significant pain relief effect (RR = -4.08, 95% CI = -7.36 to -0.65, P = -0.80) with a heterogeneity of I2 = 48% (P = 0.14). Most studies showed there was no difference in the patient's need for analgesics. EMLA was effective for reducing pain during EWSL. However, this analgesic effect was limited and did not reduce the need for analgesics.
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Huang Y, Chai S, Wang D, Li W, Zhang X. Efficacy of Eutectic Mixture of Local Anesthetics on Pain Control During Extracorporeal Shock Wave Lithotripsy: A Systematic Review and Meta-Analysis. Med Sci Monit 2020; 26:e921063. [PMID: 32400392 PMCID: PMC7245063 DOI: 10.12659/msm.921063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The efficacy of a eutectic mixture of local anesthetics (EMLA) for pain control in extracorporeal shock wave lithotripsy is unclear. The aim of this study was to assess the effect of EMLA cream on pain control during extracorporeal shock wave lithotripsy. Material/Methods We searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials to identify relevant randomized controlled trials that compared the pain control efficacies of EMLA vs. placebo. Study eligibility criteria, participants, and interventions: Randomized controlled trials that compared the effect of EMLA with placebo cream for patients underwent extracorporeal shock wave lithotripsy. Study appraisal and synthesis methods: Two review authors extracted data independently using a designed data extraction form and risk of bias by Cochrane Collaboration’s tool. Results Nine studies, including 10 randomized controlled trials with 1167 patients, were eligible. The EMLA group experienced less pain (mean difference, −0.47; 95% confidence interval, −0.78 to −0.16; p=0.003) and shorter duration of lithotripsy (mean difference, −1.70, 95% confidence interval: −2.31 to −1.10, p<0.0001) than the placebo group. There were no significant differences in the number of patients who needed extra intravenous medication (p=0.610), number of patients with insufficient extracorporeal shock wave lithotripsy pain control (p=0.530), and number of patients with opioid adverse effects (p=0.320). Limitations: Long interval between the studies, different kinds of lithotripters. Conclusions EMLA can reduce pain during the ESWL procedure.
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Affiliation(s)
- Yu Huang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Shuaishuai Chai
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Decai Wang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Wencheng Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Xiaoping Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
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El‐Khoury HJ, Brookes JDL, Tan B, Shahbaz S, McCahy PJ. Impact of modern media on analgesic requirements during extracorporeal shockwave lithotripsy. ANZ J Surg 2019; 90:53-56. [DOI: 10.1111/ans.15446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/20/2019] [Accepted: 08/06/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Hanna J. El‐Khoury
- Department of UrologyCasey Hospital, Monash Health Melbourne Victoria Australia
| | - John D. L. Brookes
- Department of UrologyCasey Hospital, Monash Health Melbourne Victoria Australia
| | - Bryan Tan
- Department of UrologyCasey Hospital, Monash Health Melbourne Victoria Australia
| | - Shekib Shahbaz
- Department of UrologyCasey Hospital, Monash Health Melbourne Victoria Australia
| | - Philip J. McCahy
- Department of UrologyCasey Hospital, Monash Health Melbourne Victoria Australia
- School of Clinical SciencesMonash University Melbourne Victoria Australia
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Daly KM, Chaker K, Rhouma SB, Chehida MAB, Ouanes Y, Sellami A, Nouira Y. [Evaluation of protocols on the use of analgesics for pain management in patients with extracorporeal shock wave lithotripsy (ESWL)]. Pan Afr Med J 2019; 32:109. [PMID: 31223399 PMCID: PMC6560981 DOI: 10.11604/pamj.2019.32.109.17690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 01/27/2019] [Indexed: 11/11/2022] Open
Abstract
La douleur ressentie au cours d'une séance de lithotritie extracorporelle (LEC) est le facteur limitant le plus important de cette technique. Le but de notre travail était de comparer l'efficacité des différents types d'analgésiques utilisés pour le contrôle de la douleur pendant les séances de LEC. Nous avons mené une étude prospective colligeant 300 patients présentant une lithiase urinaire justifiant un traitement par LEC. Les patients ont été répartis de façon randomisée en trois groupes: le groupe I, incluant 100 patients ayant reçu 2cc de sérum physiologique en IM (intra musculaire) (placebo), le groupe II regroupant 100 patients ayant reçu 100mg de kétoprofène en IM tandis que le groupe III colligeant 100 patients ayant eu une application locale d'une crème contenant la lidocaïne et la prilocaïne. L'échelle visuelle analogique (EVA) a servi à évaluer la douleur à 10 minutes et à la fin de la séance. L'EVA moyenne à 10 minutes et à la fin de la LEC étaient respectivement de 3,7 et 4,91. Aucune différence significative n'a été trouvée entre les trois groupes concernant: les données épidémiologiques (âge, sexe, IMC, antécédents pathologies) et les caractéristiques du calcul (côté, taille, localisation, présence ou non de sonde double J). L'interruption précoce de la séance de LEC a été notée chez 11 patients du groupe I, avec une différence significative par rapport aux autres groupes (p=0,003). L'EVA à 10 minutes et à la fin de séance de LEC, était statistiquement plus élevée dans le groupe I par rapport aux groupes II et III (p < 0,001). Aussi, la LEC était nettement plus efficace dans les groupes (II et III) comparativement au groupe I (p<0,001). L'utilisation d'un traitement antalgique est nécessaire lors de la séance de lithotritie extracorporelle. Les deux molécules antalgiques évaluées ont montré un bon contrôle de la douleur ainsi qu'une augmentation de l'efficacité du traitement par lithotritie.
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Affiliation(s)
- Kheireddine Mrad Daly
- Service d'Urologie, Hôpital La Rabta, Faculté de Médecine de Tunis, Université de Tunis, El Manar, Tunisie
| | - Kays Chaker
- Service d'Urologie, Hôpital La Rabta, Faculté de Médecine de Tunis, Université de Tunis, El Manar, Tunisie
| | - Sami Ben Rhouma
- Service d'Urologie, Hôpital La Rabta, Faculté de Médecine de Tunis, Université de Tunis, El Manar, Tunisie
| | - Mohamed Ali Ben Chehida
- Service d'Urologie, Hôpital La Rabta, Faculté de Médecine de Tunis, Université de Tunis, El Manar, Tunisie
| | - Yassine Ouanes
- Service d'Urologie, Hôpital La Rabta, Faculté de Médecine de Tunis, Université de Tunis, El Manar, Tunisie
| | - Ahmed Sellami
- Service d'Urologie, Hôpital La Rabta, Faculté de Médecine de Tunis, Université de Tunis, El Manar, Tunisie
| | - Yassine Nouira
- Service d'Urologie, Hôpital La Rabta, Faculté de Médecine de Tunis, Université de Tunis, El Manar, Tunisie
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Maldonado-Avila M, Garduño-Arteaga LM, Vela-Mollinedo RA, Jaspersen-Gastelum J, Virgen-Gutierrez F, Del Rosario-Santiago M, Rios-Davila V. Comparison of three analgesic drug regimens with twelfth subcostal nerve block for pain control during extracorporeal shock wave lithotripsy. Int Urol Nephrol 2017; 50:49-53. [DOI: 10.1007/s11255-017-1746-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/07/2017] [Indexed: 12/27/2022]
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Waqas M, Butt A, Ayaz Khan M, Khan I, Saqib IUD, Hussain T, Akhter S. Comparison of Different Analgesia Drug Regimens for Pain Control During Extracorporeal Shock Wave Lithotripsy for Renal Stones: A Randomized Control Study. Cureus 2017; 9:e1195. [PMID: 28560121 PMCID: PMC5446220 DOI: 10.7759/cureus.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 04/26/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION With the increased use of extracorporeal shock wave lithotripsy (ESWL), the management of urolithiasis has become much convenient for the patients and the health care professionals alike. However, associated with the procedure is the common complaint of pain. No agreed upon pain management strategy has yet been developed for the procedure. We compared the effect of different analgesia drug regiments for pain control. METHODOLOGY A randomised controlled trial was carried out in Shifa International Hospital from between July 2015 to January 2016. A total of 135 patients were divided into three groups; group A received 30 g lidocaine 2% gel applied locally on corresponding lumber area 30 minutes before the procedure, group B received oral naproxen sodium 550 mg 45 minutes before the procedure, and group C received both oral naproxen and lidocaine gel. Patients were supplemented with intravenous nalbuphine during the procedure. The pain was assessed with 0-10 visual analogue scale. Both pre-procedure and post-procedure pain score was measured. RESULTS Among 135 patients, 105 (77.8%) were male and 29 (21.5%) were female with mean age of 38.7 ± 1.31 years. There was no difference of mean pain score or need for supplemental intravenous nalbuphine between groups B and C but there was significantly decreased mean pain score and need for supplemental intravenous nalbuphine in groups B and C in comparison with group A. CONCLUSION The use of oral naproxen sodium with or without the addition of lidocaine gel during ESWL is a promising option for pain management during the procedure with significant improvement in comparison with lidocaine gel alone.
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Affiliation(s)
- Muhammad Waqas
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
| | - Amna Butt
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
| | - Mohammad Ayaz Khan
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
| | - Ijaz Khan
- Department of Urology, Pakistan Kidney Institute, Islamabad, Pakistan
| | - Imad-Ud-Din Saqib
- Department of Plastic Surgery, Shifa International Hospital, Islamabad, Pakistan
| | - Tariq Hussain
- Lithotripsy Department, Shifa International Hospital, Islamabad, Pakistan
| | - Saeed Akhter
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
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Schoenig A, Vedrine N, Costilles T, Boiteux JP, Guy L. [Pain evaluation during extracorporeal lithotropsy]. Prog Urol 2014; 24:777-82. [PMID: 25193790 DOI: 10.1016/j.purol.2014.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 04/18/2014] [Accepted: 06/15/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to demonstrate the feasibility of extracorporeal lithotripsy using lithotripter Sortz MODULITH SLK(®) without analgesics. MATERIALS AND METHODS An anonymous self-administered questionnaire was sent to 854 patients post-shock wave lithotripsy for urinary lithiasis. No patient had pain medication. The questionnaire included seven questions to assess the pain symptoms due to treatment. After 15 days, a reminder letter was sent. RESULTS The response rate was 69% (591/854). The extracorporeal lithotripsy without analgesic treatment was generally well tolerated. About 70% of patients felt just a few or no pain and average pain assessment was 3.6/10 on VAS. The pain was often considered to be multifactorial, related to the treatment itself, the duration of the session and the position on the table. Anxiety seemed to play an equally important role in pain relief with an average VAS 4.5 against 2.9 for non-anxious patients. If a new session of extracorporeal lithotripsy was necessary, 53% of patients would require no pain medication. CONCLUSIONS The extracorporeal lithotripsy could easily be done without systematic analgesics allowing for outpatient care. In contrast, anxiety seemed to be an important predictor of poor tolerance of sessions so the idea of a prophylactic anxiolytic treatment based on psychological profile of the patient should allow less aggressive and less costly management of urolithiasis.
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Affiliation(s)
- A Schoenig
- Service d'urologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalemberg, 63000 Clermont-Ferrand, France.
| | - N Vedrine
- Service d'urologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalemberg, 63000 Clermont-Ferrand, France
| | - T Costilles
- Service d'urologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalemberg, 63000 Clermont-Ferrand, France
| | - J-P Boiteux
- Service d'urologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalemberg, 63000 Clermont-Ferrand, France
| | - L Guy
- Service d'urologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalemberg, 63000 Clermont-Ferrand, France
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Aspects on how extracorporeal shockwave lithotripsy should be carried out in order to be maximally effective. ACTA ACUST UNITED AC 2012; 40:433-46. [DOI: 10.1007/s00240-012-0485-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 05/22/2012] [Indexed: 01/20/2023]
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Ozkan F, Erdemir F, Erkorkmaz U, Kaya Z, Senayli Y, Parlaktas BS. Comparison of three different analgesic protocols during shockwave lithotripsy. J Endourol 2011; 26:691-6. [PMID: 22050496 DOI: 10.1089/end.2011.0004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Shockwave lithotripsy (SWL) is one of the most important treatment modalities for urinary stone disease. The procedure may cause pain, and patient relaxation and cooperation are crucial in maintaining stone localization for optimal fragmentation and patient comfort during the procedure. As yet, there is not a standard analgesic protocol for patients undergoing SWL. We aimed to use three different analgesic agents and compare their efficacy during SWL in this study. PATIENTS AND METHODS Written informed consents were obtained from 95 patients with kidney stones, and they were randomized to receive lornoxicam (group L, n=32 patients), paracetamol (group P, n=31 patients), and tramadol with a patient-controlled analgesia device (group T, n=32 patients). All groups received patient-controlled analgesia with tramadol during the SWL procedure. The intensity of pain was evaluated with a visual analog scale (VAS). RESULTS The mean age of the patients was 41.87 ± 16.53 years, 44.07 ± 11.48 years, and 41.24 ± 14.82 years in group L, group P, and group T, respectively. No significant differences were found between the three groups concerning patient age, stone location, or session duration (P>0.05). The mean VAS scores and analgesic consumption were lower in group L compared with other groups (P<0.05). CONCLUSION The results of this study showed that additional administration of analgesics was decreased with intravenous lornoxicam in comparison with paracetamol and only tramadol.
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Affiliation(s)
- Fatih Ozkan
- Department of Anesthesiology, Gaziosmanpasa University, Tokat, Turkey
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Drugs for pain management in shock wave lithotripsy. PAIN RESEARCH AND TREATMENT 2011; 2011:259426. [PMID: 22135735 PMCID: PMC3216367 DOI: 10.1155/2011/259426] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Accepted: 08/29/2011] [Indexed: 11/17/2022]
Abstract
Objective. With this review, we provide a comprehensive overview of the main aspects and currently used drugs for analgesia in shockwave lithotripsy. Evidence Acquisition. We reviewed current literature, concentrating on newer articles and high-quality reviews in international journals. Results. No standardized protocols for pain control in SWL exist, although it is crucial for treatment outcome. General and spinal anaesthesia show excellent pain control but are only recommended for selected cases. The newer opioids and nonsteroidal anti-inflammatory drugs are able to deliver good analgesia. Interest in inhalation anaesthesia with nitrous oxide, local anaesthesia with deep infiltration of the tissue, and dermal anaesthesia with EMLA or DMSO has recently rekindled, showing good results in terms of pain control and a favourable side effect profile. Tamsulosin and paracetamol are further well-known drugs being currently investigated. Conclusion. Apart from classically used drugs like opioids and NSARs, medicaments like nitrous oxide, paracetamol, DMSA, or refined administration techniques for infiltration anaesthesia show a good effectiveness in pain control for SWL.
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Gupta NP, Kumar A. Analgesia for pain control during extracorporeal shock wave lithotripsy: Current status. Indian J Urol 2011; 24:155-8. [PMID: 19468389 PMCID: PMC2684259 DOI: 10.4103/0970-1591.40607] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose of Review A cooperative patient is essential in maintaining stone targeting for optimal fragmentation during extracorporeal shock wave lithotripsy (ESWL). Therefore, it is important to choose an appropriate analgesic with minimal adverse effects. The guidelines for pain management during ESWL have not been established. Current Status Various analgesic agents including opioids (morphine, pethidine, and fentanyl), nonsteroidal anti-inflammatory drugs (NSAIDS - diclofenac, propofol, ketorolac, and piroxicam), local anesthetic agents and a number of combinations have been used during ESWL by various techniques (general anesthesia, regional anesthesia, subcutaneous and intravenous injections, patient-controlled analgesia, and monitored anesthesia care). Cutaneous creams like eutectic mixture of local anesthesia (EMLA) whether used alone or in combination with oral NSAIDS have also been used and are able to reduce analgesic requirements. Topical application of a combination of dimethyl sulfoxide and lidocaine has also been found to be effective. Conclusion The ideal analgesic, offering optimal pain control, minimal side effects, and cost-effectiveness is still elusive. Opioids administered using various techniques, provide effective analgesia, but require active monitoring of patient for potential adverse effects. Combination therapy (oral NSAID and occlusive dressing of EMLA, DMSO with lidocaine) offers an effective alternative mode for achieving analgesia with minimal morbidity. This therapy avoids the need for general anesthesia, injectable analgesics, and opioids along with their side effects.
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Affiliation(s)
- Narmada P Gupta
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Madbouly K, Alshahrani S, Al-Omair T, Matrafi HA, Mansi M. Efficacy of local subcutaneous anesthesia versus intramuscular opioid sedation in extracorporeal shockwave lithotripsy: a randomized study. J Endourol 2011; 25:845-9. [PMID: 21417936 DOI: 10.1089/end.2010.0427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate the analgesic efficacy of local subcutaneous (SC) anesthesia compared with intramuscular (IM) opioid sedation during extracorporeal shockwave lithotripsy (SWL) in a randomized study. PATIENTS AND METHODS After informed consent was obtained, 125 patients with urolithiasis who were scheduled for SWL were included in the study. The patients in each treatment session were randomized to receive either IM meperidine (group A) or SC infiltration of 10 mL 2% lidocaine and 10 mL 0.5% bupivacaine at the area of shockwave entry (group B). Degree of pain was rated by the patient using a five-point visual analogue scale (VAS). RESULTS The study included 88 (70.4%) men and 37 (29.6%) women with a mean age of 47.6 ± 12.5 years and a mean body mass index (BMI) of 28.16 ± 4.67 kg/m2. Of the patients, 89, 26, and 10 received a single, two, or more than two treatment sessions, respectively (176 sessions). Maximum stone length was 10.68 ± 5.12 mm. Pretreatment stent placement was performed in 17 (13.6%) patients (28 sessions). Group A comprised 89 treatment sessions while 87 were involved in group B. Both groups were similar. Supplemental intrvenous sedation was needed in two (2.5%) and four (4.6%) sessions in groups A and B, respectively. VAS was not different between both groups (P = 0.063). Patients with pretreatment stent placement had significantly lower VAS score compared with patients without stents (P = 0.012). Sex and BMI had no impact on the VAS score. CONCLUSIONS Local SC anesthesia alone is effective for analgesic purposes during extracorporeal SWL. Sex, age, and BMI have no relation to analgesia requirement.
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Affiliation(s)
- Khaled Madbouly
- Department of Surgery, Division of Urology, King Fahad National Guard Hospital, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia.
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Mezentsev VA. Meta-analysis of the efficacy of non-steroidal anti-inflammatory drugs vs. opioids for SWL using modern electromagnetic lithotripters. Int Braz J Urol 2010; 35:293-7; discussion 298. [PMID: 19538764 DOI: 10.1590/s1677-55382009000300005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2009] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Clinical studies produce conflicting results on pain relief for shock wave lithotripsy (SWL). We performed a systematic review and meta-analysis to compare non-steroidal anti-inflammatory drugs (NSAIDs) and opioids in pain relief for SWL powered by an electromagnetic generator. MATERIAL AND METHODS A search of MEDLINE and EMBASE was performed and all randomized controlled trials comparing NSAIDs and opioids in pain relief for SWL using modern electromagnetic lithotripters were included in the analysis. Data from 3 trials (244 patients) were pooled. The primary outcome measure was adequate analgesia, defined as "if no additional pain relief was used". The difference in the proportion of patients with adequate anesthesia was compared between the NSAIDs and opioids groups as an odds ratio and odds ratio were pooled across the 3 trials with a fixed effects model. RESULTS There was no statistically significant difference between using NSAIDs and opioids for pain relief during SWL using modern electromagnetic lithotripters (odds ratio 0.886, 95% CI 0.446-1,760, p = 0.730). CONCLUSIONS Our analysis shows that in relieving pain during SWL using modern electromagnetic lithotripters NSAIDs are as effective as opioids.
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Affiliation(s)
- V A Mezentsev
- Harrogate and District NHS Foundation Trust, Yorkshire Deanery, England, United Kingdom.
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Tokgöz H, Hanci V, Türksoy O, Erol B, Akduman B, Mungan NA. Pain perception during shock wave lithotripsy: does it correlate with patient and stone characteristics? J Chin Med Assoc 2010; 73:477-82. [PMID: 20875621 DOI: 10.1016/s1726-4901(10)70102-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 05/28/2010] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To investigate the correlation of various clinical parameters [number of shock wave lithotripsy (SWL) sessions, body mass index, patient age, gender, and stone characteristics] with pain perception during the SWL procedure. METHODS A total of 88 patients who underwent 165 SWL sessions for renal or ureteral stones in our institution were included in the study. The degree of pain perception during the procedure was evaluated with a 10-point visual analog scale. RESULTS A significant p value was reached when the cut-off value for stone burden was taken as 100 mm(2). Mean pain scores during the SWL procedures were affected by gender and the number of SWL sessions. However, they were not affected by laterality, patient age, body mass index, and location of stones. CONCLUSION Our results suggest that patient comfort is better during the first SWL session than in the following sessions for renal or ureteral stones with a stone burden of less than 100 mm(2). In addition, severity of pain during SWL treatment may be better tolerated in males than in females.
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Affiliation(s)
- Hüsnü Tokgöz
- Department of Urology, Zonguldak Karaelmas University School of Medicine, Kozlu/Zonguldak, Turkey.
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Tokgoz H, Yurtlu S, Hanci V, Turksoy O, Erol B, Akduman B, Mungan A. Comparison of the Analgesic Effects of Dexketoprofen and Diclofenac During Shockwave Lithotripsy: A Randomized, Double-Blind Clinical Trial. J Endourol 2010; 24:1031-5. [DOI: 10.1089/end.2009.0257] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Husnu Tokgoz
- Department of Urology, Karaelmas University, School of Medicine, Zonguldak Turkey
| | - Serhan Yurtlu
- Department of Anesthesiology, Karaelmas University, School of Medicine, Zonguldak Turkey
| | - Volkan Hanci
- Department of Anesthesiology, Karaelmas University, School of Medicine, Zonguldak Turkey
| | - Ozlem Turksoy
- Department of Radiology, Karaelmas University, School of Medicine, Zonguldak Turkey
| | - Bulent Erol
- Department of Urology, Karaelmas University, School of Medicine, Zonguldak Turkey
| | - Bulent Akduman
- Department of Urology, Karaelmas University, School of Medicine, Zonguldak Turkey
| | - Aydin Mungan
- Department of Urology, Karaelmas University, School of Medicine, Zonguldak Turkey
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Berwin JT, El-Husseiny T, Papatsoris AG, Hajdinjak T, Masood J, Buchholz N. Pain in extracorporeal shock wave lithotripsy. ACTA ACUST UNITED AC 2009; 37:51-3. [PMID: 19183979 DOI: 10.1007/s00240-009-0171-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2008] [Accepted: 01/09/2009] [Indexed: 12/01/2022]
Affiliation(s)
- James Theo Berwin
- Endourology and Stone Services, Barts and The London NHS Trust, London, UK.
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