Local Anesthesia with 20-mL Prilocaine Infiltration: The Ultimate Point for Analgesia during Shockwave Lithotripsy?

Drugs for pain management in shock wave lithotripsy

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.

Pain perception during shock wave lithotripsy: does it correlate with patient and stone characteristics?

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.