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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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Law YXT, Kesavan A, Loke W, Chua WJ, Tai BC, Shen L, Tiong HY, Chen WJK. Does addition of aromatherapy and music help to reduce pain and anxiety during shockwave lithotripsy compared to standard analgesia alone? A randomised controlled trial. Int Urol Nephrol 2023; 55:2405-2410. [PMID: 37395910 DOI: 10.1007/s11255-023-03684-0] [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: 04/03/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To assess the effect of aromatherapy with lavender oil alone, and in combination with music, on pain and anxiety during extracorporeal shockwave lithotripsy for kidney stones. METHODS This was a single-centre prospective, randomised controlled trial. The subjects were block randomised into 3 study groups, Group 1: Control; Group 2: Aromatherapy only; Group 3: Aromatherapy and music. All subjects were given patient-controlled intravenous alfentanil as standard analgesia. The primary outcome measures were pain and anxiety scores using visual analogue scale (VAS) and State-Trait Anxiety Inventory. RESULTS Ninety patients were recruited and randomised prospectively into Group 1 (n = 30), Group 2 (n = 30), and Group 3 (n = 30). For pain outcome, both Group 2 and Group 3 showed a trend towards lower mean VAS pain scores of 2.73 in both groups compared to the control with a mean VAS score of 3.50, but it was not statistically significant (p = 0.272). There was no significant difference in anxiety scores between groups post-treatment. CONCLUSIONS Our study was unable to show a significant improvement in pain relief and anxiety when aromatherapy with lavender oil was added to standard analgesia alone during shockwave lithotripsy. There was also no difference when aromatherapy was combined with music.
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Affiliation(s)
- Yu Xi Terence Law
- Department of Urology, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 8, Singapore, 119228, Singapore.
| | - Arshvin Kesavan
- Department of Urology, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 8, Singapore, 119228, Singapore
| | - Wayren Loke
- Department of Urology, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 8, Singapore, 119228, Singapore
| | - Wei Jin Chua
- Department of Urology, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 8, Singapore, 119228, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 8, Singapore, 119228, Singapore
| | - Wei Jing Kelven Chen
- Department of Urology, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 8, Singapore, 119228, Singapore
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Chen HT, Hung KC, Hsu YC, Kuo JR, Chang YJ, Chen IW, Sun CK. Efficacy of acupuncture for pain relief in patients receiving extracorporeal shock wave lithotripsy: a meta-analysis of randomized controlled studies. Front Med (Lausanne) 2023; 10:1114485. [PMID: 37332744 PMCID: PMC10272834 DOI: 10.3389/fmed.2023.1114485] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
Background This meta-analysis aimed at investigating the efficacy of acupuncture for pain relief in patients receiving extracorporeal shock wave lithotripsy (ESWL). Methods Randomized controlled trials comparing the efficacy of acupuncture with conventional treatments were retrieved from major electronic databases (e.g., MEDLINE, EMBASE, and Cochrane Library) until August 28, 2022. The primary outcome was the response rate (i.e., rate of pain relief), while secondary outcomes included stone-free rate, satisfaction rate, duration of ESWL, peri-/post-procedural pain score, and risk of adverse events. Results Thirteen eligible studies involving 1,220 participants published between 1993 and 2022 were analyzed. Pooled results indicated that acupuncture had a better response rate compared to conventional treatments (RR = 1.17, 95% CI: 1.06-1.3, p = 0.003, seven trials, n = 832). Despite no difference in ESWL duration (MD = 0.02 min, 95% CI: -1.53 to 1.57, p = 0.98, three trials, n = 141), stone-free rate (RR = 1.11, 95% CI: 1-1.25, p = 0.06, six trials, n = 498), and satisfaction rate (RR = 1.51, 95% CI: 0.92-2.47, p = 0.1, three trials, n = 334) between the two groups, the acupuncture group had a lower risk of adverse events (RR = 0.51, 95% CI: 0.33-0.79, p = 0.003, five trials, n = 327), peri- (MD = -1.91 points, 94% CI: -3.53 to -0.28, p = 0.02, four trials, n = 258 patient) and post-procedural (MD = -1.07, 95% CI: -1.77 to -0.36, p = 0.003, four trials, n = 335) pain score. Conclusion The results of this meta-analysis showed that the use of acupuncture in patients receiving ESWL was associated with a higher pain relief rate and a lower risk of adverse events, suggesting feasibility of its use in this clinical setting. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022356327.
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Affiliation(s)
- Hsiao-Tien Chen
- Department of Chinese Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Yao-Chin Hsu
- Department of Chinese Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Recreation and Health-Care Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
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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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Ketsuwan C, Leenanupunth C, Phengsalae Y, Sangkum P, Kongchareonsombat W, Kaewjai N, Timjapoe P. Prospective Randomized Controlled Trial to Evaluate the Effectiveness of Watching Movies to Decrease Anxiety During Extracorporeal Shock Wave Lithotripsy. Res Rep Urol 2021; 13:97-104. [PMID: 33659222 PMCID: PMC7920589 DOI: 10.2147/rru.s299358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background Extracorporeal shock wave lithotripsy (ESWL) is the only non-invasive treatment for urolithiasis; however, it can cause anxiety and pain for patients. Several new nonpharmacological adjuvant approaches have been developed to reduce adverse events. Objective To analyze the efficacy of watching movies during ESWL to relieve anxiety and pain. Methods A total of 84 patients were randomly divided into two groups. The experimental group consisted of 42 patients who watched their own selected movies during the ESWL session, while the control group included 42 patients who did not watch movies. Basic characteristics, hemodynamic parameters, State-Trait Anxiety Inventory, Visual Analog Scale for pain, willingness to repeat the procedure, and patient satisfaction rates were collected and analyzed. Results After watching movies during ESWL, patients had a significantly lower anxiety level (p = 0.001) and a higher satisfaction rate (p = 0.021). No statistically significant differences were found in terms of demographic data, hemodynamic parameters, pain scores, or willingness to repeat the procedure. Conclusion Watching self-selected movies during an ESWL can effectively reduce anxiety and improve satisfaction.
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Affiliation(s)
- Chinnakhet Ketsuwan
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Charoen Leenanupunth
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Yada Phengsalae
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Premsant Sangkum
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Wisoot Kongchareonsombat
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Nongnart Kaewjai
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Phanida Timjapoe
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
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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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Browne C, Redmond E, Kelly T, Rogers E, O'Malley P, Nusrat N, Jaffry S, Durkan G, Walsh K, Dowling C, D'Arcy FT. Strategies to maximise patient comfort during extracorporeal shockwave lithotripsy - A randomised controlled trial. Surgeon 2020; 19:207-211. [PMID: 32771299 DOI: 10.1016/j.surge.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/19/2020] [Accepted: 07/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND/PURPOSE OF STUDY We aim to assess if distraction techniques improve patient comfort tolerability of SWL. METHODS We carried out a prospective randomised controlled trial of SWL-naïve patients attending for treatment. Patients were randomised into three groups and offered oral analgesia as standard of care. Group 1 (n = 19) received stress balls to squeeze during treatment. Group 2 (n = 19) listened to music during treatment. Group 3 (n = 17) received standard of care only. All patients completed a validated health anxiety inventory score prior to treatment. All patients completed a validated pain questionnaire and visual analogue scale (VAS) after treatment. Primary outcomes were completion of SWL treatment and pain score results. RESULTS 55 patients attending for SWL were randomised. There was no difference in stone size or position, presence of a stent, height or weight between the groups. VAS scores were lower in controls compared to Group 1 (1.93 vs 3.69, p = 0.08). On subgroup analysis of non-anxious patients, pain questionnaire scores were lower in controls compared to Group 1 (2.58 vs 4.77, p = 0.06). VAS scores were lower in patients who received optional analgesia alone than in patients who received stress balls alone (1.92 vs 4.07, p = 0.05). Across all subgroups, pain scores were lower in the control group compared to the distraction groups, but did not achieve significance. CONCLUSIONS In conclusion, distraction techniques should not replace standard of care for analgesia during SWL. This study was registered with clinicaltrials.gov (identifier NCT03379922).
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Affiliation(s)
- Clíodhna Browne
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland.
| | - Elaine Redmond
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Therese Kelly
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Eamonn Rogers
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Patrick O'Malley
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Nadeem Nusrat
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Syed Jaffry
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Garrett Durkan
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Kilian Walsh
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Catherine Dowling
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Frank T D'Arcy
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
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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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Lee SM, Collin N, Wiseman H, Philip J. Optimisation of shock wave lithotripsy: a systematic review of technical aspects to improve outcomes. Transl Androl Urol 2019; 8:S389-S397. [PMID: 31656745 DOI: 10.21037/tau.2019.06.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Shock wave lithotripsy (SWL) remains an important treatment option for the management of upper urinary tract stones. The optimisation of certain technical principles can help to improve the results of SWL. We performed a systematic review based on preferred reporting items for systematic review and meta-analysis (PRISMA) standards for studies reporting on technical aspects of SWL. A literature search was conducted on the PubMed database between January 1984 and November 2018 using 'shockwave lithotripsy' and 'stone' as keywords. Summaries and manuscripts of relevant articles were reviewed in order to select studies with the best level of evidence in each theme covered during the review. From 4,135 titles, 165 abstracts and full-text articles were reviewed. Overall, SWL has good outcomes in the treatment of upper urinary tract stones. It remains the only truly non-invasive stone treatment. While stone-free rate (SFR) might not be equivalent to ureteroscopy or percutaneous nephrolithotomy outcomes, SWL can be optimised by changing several technical factors, including type of machine, patient position, number, rate and energy of shocks, stone targeting, and patient analgesia. For each of these included SWL themes, relevant and selected studies with the highest level of evidence were described and discussed. Paired with these improved technical factors and appropriate patient selection, SWL, with its low complication rates, remains an excellent treatment option in 2019.
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Affiliation(s)
- Su-Min Lee
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Neil Collin
- Department of Interventional Radiology, Southmead Hospital, Bristol, UK
| | - Helen Wiseman
- Department of Interventional Radiology, Southmead Hospital, Bristol, UK
| | - Joe Philip
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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Shoukry RA, Al-Ansary AM. Transcutaneous Electric Nerve Stimulation (TENS) for pain relief during Extracorporeal Shock-Wave Lithotripsy (ESWL). EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1080/11101849.2019.1655202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Randa Ali Shoukry
- Department of Anesthesia, Faculty of medicine Ain-Shams University, Cairo, Egypt
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Intracutaneous sterile water injection for pain relief during extracorporeal shock wave lithotripsy: comparison with diclofenac sodium. Urolithiasis 2019; 48:103-108. [PMID: 31278470 DOI: 10.1007/s00240-019-01147-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/28/2019] [Indexed: 12/24/2022]
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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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Fouladi A, Soleimani A. Comparison of Different Analgesic Techniques for Pain Relief During Extracorporeal Shock Wave Lithotripsy: a Double-blind, Randomized Clinical Trial. Acta Inform Med 2017; 25:94-98. [PMID: 28883672 PMCID: PMC5544458 DOI: 10.5455/aim.2017.25.94-98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Most patients experience some degree of pain during extracorporeal shock waves lithotripsy (ESWL). Aim: The aim of this study was to evaluate the effect of target-controlled infusion (TCI) of remifentanil or sufentanil and patient-controlled analgesia (PCA) with sufentanil or morphine for pain relief during ESWL. Materials and Methods: In a double blind, randomized clinical trial, a total of 60 patients who were scheduled for elective ESWL, randomly assigned into four groups (A, B, C and D). Patients in group A and B received remifentanil and sufentanil with TCI, respectively. Also, patients in group C and D received sufentanil and morphine with PCA, respectively. All patients in four groups were assessed about the intensity of their pain with Visual Analogue Scale (VAS) in three phases; the discharge of the waves (phase A), during breaking the stones (phase B) and the end of the procedure (phase C). Results: Patients in morphine PCA group experienced highest pain intensity in all stages, but patients in remifentanil TCI group experienced lowest pain intensity during lithotripsy. Remifentanil/TCI group experienced the lowest pain in B and C phases and the sufentanil/TCI group had the lowest pain only in the phase A. There was no significant difference in the occurrence of complications in all four groups. Conclusion: The current study demonstrates that efficacy of TCI pump in the reduction of pain during ESWL is superior to the PCA pump. Among the drugs that used in this study, remifentanil has more effective in pain management in the all phases during ESWL. We believe that using remifentanil/TCI should strongly be considered to clinicians in ESWL units.
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Affiliation(s)
- Afsaneh Fouladi
- Department of Anesthesiology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Aria Soleimani
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Elnabtity AMA, Shabana WM. Unilateral versus bilateral ultrasound-guided transversus abdominis plane blocks during ureteric shock wave lithotripsy: A prospective randomized trial. Urol Ann 2016; 8:265-9. [PMID: 27453645 PMCID: PMC4944616 DOI: 10.4103/0974-7796.184893] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Ultrasound-guided transversus abdominis plane (TAP) block has been used for intra- and post-operative analgesia during abdominal operations and for ureteric shock wave lithotripsy (SWL) as well. Aim: This study aimed at comparing ultrasound-guided unilateral versus bilateral TAP blocks as analgesic techniques for unilateral ureteric SWL. Settings and Design: Prospective randomized comparative study. Patients and Methods: Sixty patients scheduled for unilateral ureteric SWL were randomly allocated into two groups: Group (U) received unilateral TAP block in the form of 25 ml of bupivacaine 0.25% (i.e., 62.5 mg), and Group (B) received bilateral TAP blocks in the form of 25 ml of bupivacaine 0.25% (i.e., 62.5 mg) on each side. Statistical Analysis: This was performed using SPSS program version 19 ((IBM Corp., Armonk, NY, USA) and EP 16 program. Results: The mean values of intra- and post-procedural visual analog scale at different time intervals were around (30), which was statistically insignificant between groups (P > 0.05). There were no significant differences between groups regarding cardiopulmonary stability, postanesthesia care unit time, the total amount of rescue fentanyl and patient satisfaction scores (P > 0.05). There were no significant side effects in both groups. Conclusion: Ultrasound-guided unilateral TAP block is as safe and effective analgesic technique as bilateral TAP blocks during unilateral ureteric SWL. It can be used as the sole analgesic technique during ureteric SWL.
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Affiliation(s)
- Ali Mohamed Ali Elnabtity
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Demir A, Cecen K, Karadag MA, Uslu M, Arslan OE. Pain control using pethidine in combination with diazepam compared to diclofenac in combination with hyoscine-n-butyl bromide: in patients undergoing extracorporeal shock wave lithotripsy. Cent European J Urol 2015; 68:201-6. [PMID: 26251744 PMCID: PMC4526601 DOI: 10.5173/ceju.2015.479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 10/07/2014] [Accepted: 01/02/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction Extracorporeal Shock Wave Lithotripsy (ESWL) remains the preferred least invasive treatment for urinary tract stones. The main purpose of this study was to compare two treatment modalities for pain control during the ESWL procedure. Material and methods From 2013 to 2014, 220 patients received ESWL for kidney stones. Before the procedure, the weight and height were measured to determine the body mass index (BMI); in addition, oxygen saturation and the pulse of the patients, as well as pain level were determined. The pain control provided included two different methods: diclofenac sodium plus hyoscine-N-butyl bromide in the first group and pethidine plus diazepam in the second group. The pain level of the patients was determined using two different scales: the Wong-Baker and the Visual Analogue scales (VAS). At the end of three sessions, all patients were evaluated for the stone fragmentation rate by plain abdominal X-ray, and the findings were recorded and analyzed. Results A total of 220 patients were enrolled in this study. There were 91 patients in the first group (diclofenac sodium + hyoscine-N-butyl bromide) (male/female: 63/28) and 129 (male/female: 83/46) patients in the second group (pethidine HCL +diazepam). The mean age with SD according to each group was 42.03 (±16.43) and 42.56 (±14.23), respectively (p = 0.8). With regard to pain scores (using the Wong-Baker and VAS scales), the responses were significantly lower in the second group (p <0.001). Conclusions Pethidine in combination with diazepam was superior to diclofenac and Hyoscine-N-butyl bromide for pain in patients undergoing ESWL.
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Affiliation(s)
- Aslan Demir
- Kafkas University, Medical School, Department of Urology, Kars, Turkey
| | - Kursat Cecen
- Kafkas University, Medical School, Department of Urology, Kars, Turkey
| | - Mert Ali Karadag
- Kafkas University, Medical School, Department of Urology, Kars, Turkey
| | - Mehmet Uslu
- Kafkas University, Medical School, Department of Urology, Kars, Turkey
| | - Omer Erkam Arslan
- Kafkas University, Medical School, Department of Urology, Kars, Turkey
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Elnabtity AMA, Tawfeek MM, Keera AA, Badran YA. Is unilateral transversus abdominis plane block an analgesic alternative for ureteric shock wave lithotripsy? Anesth Essays Res 2015; 9:51-6. [PMID: 25886421 PMCID: PMC4383112 DOI: 10.4103/0259-1162.150177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Various sedative and analgesic techniques have been used during shock wave lithotripsy (SWL). Aim: This study aimed at evaluating the efficacy of ultrasound-guided unilateral transversus abdominis plane (TAP) block as an analgesic technique alternative during ureteric SWL. Settings and Design: Prospective randomized comparative study. Materials and Methods: Fifty patients scheduled for ureteric SWL were randomly allocated into two equal groups: Group (F) received 1.5 mcg/kg fentanyl intravenous and group (T) received unilateral TAP block with injection of 25 ml of bupivacaine 0.25% (62.5 mg). Statistical Analysis: Statistical analysis was performed using SPSS program version 19 and EP16 program. Results: The visual analog scale was significantly less in group (T) than in group (F) both intra-operatively (at 10, 20, 30, and 40 min) and postoperatively (at 10 min intervals in the postanesthesia care unit [PACU]) (P < 0.001). Rescue analgesia with pethidine during the procedure and in the PACU was less (P < 0.001) in the group (T) than group (F) with a median of 20 mg versus 55 mg, respectively. The higher sedation scores observed in group (F) at 15, 25, and 35 min during the procedure, and at 20 min during the PACU time were statistically highly significant (P < 0.001), but only significant at 10 min (P = 0.03) and 30 min (P = 0.007) during the PACU time. There was also highly significant decrease (P < 0.001) in the time of PACU stay in group (T) (38.2 ± 6.6 min) compared with group (F) (89.2 ± 13.39 min). We recorded 6 patients in group (F) (24%) who have developed respiratory depression (respiratory rate < 10 breaths/min) compared to 0% in group (T) (P = 0.022). In addition, in group (F) nausea was noted in 8 patients (32%) and vomiting in 6 patients (24%), which was statistically significant when compared to group (T) (0%) (P = 0.01 and 0.022, respectively). Conclusion: Ultrasound-guided unilateral TAP block is an effective alternative analgesic technique during ureteric SWL.
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Affiliation(s)
- Ali Mohamed Ali Elnabtity
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed M Tawfeek
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amr Ali Keera
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Benha University, Benha, Egypt
| | - Yasser Ali Badran
- Department of Urology, Faculty of Medicine, Al Azhar University, Cairo, Egypt
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Yesil S, Polat F, Ozturk U, Dede O, Imamoglu M, Bozkirli I. Effect of different analgesics on pain relief during extracorporeal shock wave lithotripsy. Hippokratia 2014; 18:107-109. [PMID: 25336870 PMCID: PMC4201393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM The aim of this study was to compare three drugs for pain relief during shock wave lithotripsy (SWL). MATERIALS AND METHODS Seventy six male patients that were treated for renal stones with SWL were included in this study. They were randomized into four groups. A different treatment protocol was used for each group. Intramuscular (IM) diclofenac 75mg was given in group 1 (n=20), dexketoprofen, 50mg, IM in group 2 (n=20) and hyoscine 10 mg plus paracetamol 500mg, orally in group 3 (n=20). In group 4 (control, n=16) saline solution was given 30 min before SWL. Pain during SWL was assessed using the 10-score linear visual analogue pain scale (VAS) and was compared among groups. Age, weight, height, body mass index (BMI), stone size, stone location, duration of SWL, total shock waves performed and mean energy level (kV) for each patient were recorded. A p value of <0.05 was considered statistically significant. RESULTS The mean patients' age was 45.4 ± 12.9 years. The highest VAS value was observed in Group 4 (8.4 ± 1), and the lowest in Group 1 (6.25 ± 2.2). Statistically significant difference was noted only when Group 1 and Group 4 were compared. The remaining groups provided similar results and there were no significant statistical differences according to VAS values. Other parameters were similar in all groups. CONCLUSION In conclusion, this study shows that reducing the pain with a single dose injection of intramuscular diclofenac sodium before SWL is superior compared to others.
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Affiliation(s)
- S Yesil
- Department of Urology, Faculty of Medicine, Gazi University, Besevler, Turkey
| | - F Polat
- Department of Urology, Faculty of Medicine, Gazi University, Besevler, Turkey
| | - U Ozturk
- Department of Urology, Diskapi Yildirim Beyazit Training and Research Hospital, Dişkapi, Ankara, Turkey
| | - O Dede
- Department of Urology, Diskapi Yildirim Beyazit Training and Research Hospital, Dişkapi, Ankara, Turkey
| | - Ma Imamoglu
- Department of Urology, Diskapi Yildirim Beyazit Training and Research Hospital, Dişkapi, Ankara, Turkey
| | - I Bozkirli
- Department of Urology, Faculty of Medicine, Gazi University, Besevler, Turkey
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Kang JH, Lee SW, Moon SH, Sung HH, Choo SH, Han DH. Relationship Between Patient Position and Pain Severity During Shock Wave Lithotripsy for Renal Stones With the MODULITH SLX-F2 Lithotripter: A Matched Case-Control Study. Korean J Urol 2013; 54:531-5. [PMID: 23956829 PMCID: PMC3742906 DOI: 10.4111/kju.2013.54.8.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 06/21/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We evaluated the association between shock wave lithotripsy (SWL)-related pain and patient positioning during SWL. MATERIALS AND METHODS We retrospectively reviewed the medical records of 162 patients who underwent their first SWL session for single renal stones from May 2010 to August 2011. One hundred thirteen patients underwent SWL in the supine position and 49 did so in the lateral position. To evaluate an unbiased estimation of the positional effect on pain severity during SWL, both groups (supine vs. lateral) were matched according to sex, age, body mass index, stone location, and stone size. Thirty-four patients from each group were selected for analysis. Pain was evaluated with an average visual analogue scale (VAS-avg) and maximum visual analogue scale (VAS-max). Analgesic usage was also compared between the groups. RESULTS All patients (n=34) in the supine group had radio-opaque stones compared with only 47.1% of the patients in the lateral group (n=16). The VAS-avg and VAS-max of the lateral group were significantly lower than those of the supine group (1.2±1.0 and 3.1±1.7 for VAS-avg and 2.5±1.8 and 4.7±1.9 for VAS-max, respectively, p<0.05). However, analgesic usage between groups did not differ significantly (17.6% in the supine group vs. 5.9% in the lateral group, p=0.259). In a subgroup analysis confined to patients with radio-opaque stones, the supine group still suffered more pain. CONCLUSIONS Patients with renal stones suffered more SWL-related pain in the supine position than in the lateral position. During SWL, positioning of patients should be considered a predictive factor for SWL-related pain.
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Affiliation(s)
- Jung Hun Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Acar A, Erhan E, Nuri Deniz M, Ugur G. The Effect of EMLA Cream on Patient-Controlled Analgesia with Remifentanil in ESWL Procedure: A Placebo-Controlled Randomized Study. Anesth Pain Med 2013; 2:119-22. [PMID: 24244921 PMCID: PMC3821126 DOI: 10.5812/aapm.7790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 09/01/2012] [Accepted: 10/10/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To alleviate stinging pain in the skin entry area and visceral discomfort in patients who are undergoing ESWL. OBJECTIVES This study was designed to investigate the effectiveness of the EMLA cream in combination with remifentanil patient-controlled analgesia (PCA) in patients undergoing ESWL treatment. PATIENTS AND METHODS Sixty patients were divided into two double-blind randomized groups. Those in the first group were administered 3-5mm of EMLA 5% cream on a marked area; the second group received, as a placebo, a cream with no analgesic effect in the same amount. All patients were administered a remifentanil bolus with a PCA device. Arterial blood pressure, oxygen saturation, and respiratory rate were recorded throughout the procedure; postoperative side effects, agitation, and respiratory depression were measured after. Visual Analogue Scale (VAS) scores were taken preoperatively, perioperatively, directly postoperatively, and 60 minutes subsequent to finishing the procedure. RESULTS There were no statistically significant differences in the frequency of PCA demands and delivered boluses or among perioperative VAS. No significant side effects were noted. Patient satisfaction was recorded high in both groups. CONCLUSIONS EMLA cream offered no advantage over the placebo cream in patients undergoing ESWL with remifentanil PCA.
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Affiliation(s)
- Arzu Acar
- Department of Anaesthesiology and Reanimation, School of Medicine, Ege University, Izmir, Turkey
| | - Elvan Erhan
- Department of Anaesthesiology and Reanimation, School of Medicine, Ege University, Izmir, Turkey
| | - M. Nuri Deniz
- Department of Anaesthesiology and Reanimation, School of Medicine, Ege University, Izmir, Turkey
- Corresponding author: M. Nuri Deniz, Department of Anaesthesiology and Reanimation, School of Medicine, Ege University, 35100, Izmir, Turkey. Tel.: +90-2323902140, Fax: +90-2323397687, E-mail:
| | - Gulden Ugur
- Department of Anaesthesiology and Reanimation, School of Medicine, Ege University, Izmir, Turkey
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Topical EMLA for pain control during extracorporeal shock wave lithotripsy: prospective, comparative, randomized, double-blind study. ACTA ACUST UNITED AC 2012; 40:575-9. [DOI: 10.1007/s00240-012-0468-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 02/04/2012] [Indexed: 10/28/2022]
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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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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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