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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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Cao W, Chen J, Wu L, Xu YH, Meng Y, Li X, Zheng Z, Chu X. A Novel Molecular Reservoir Based on Reverse Self-Assembled Liquid Crystals - A New Strategy for Prolonging the Duration in Action of Analgesics. J Pharm Sci 2023; 112:1985-1996. [PMID: 37088153 DOI: 10.1016/j.xphs.2023.04.010] [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: 12/09/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The aim of this study was to develop liquid crystal (LC) precursors to obtain novel long-acting analgesics for injection based on depot systems and compare the difference between the cubic and hexagonal precursors in delivering Diclofenac sodium (DS). METHODS Diclofenac sodium liquid crystal precursor injections were prepared and characterized, followed by in vitro release, pharmacodynamic, and pharmacokinetic studies. RESULTS The optimal formulations were prepared with a ratio of Phytantriol/ethanol/water as 76:19:5 for cubic LC precursors, and a ratio of Phytantriol/ethanol/water/Vitamine-E acetate as 72:18:5:5 for hexagonal, both loading various drug dosages (2.5%, 3.75% and 5%), respectively. Polarized light microscopy and small angle diffraction confirmed that the precursors were isotropic fluids and transformed into gels with Pn3m or HII framework in water. Rheological studies have shown that precursors belong to Newtonian fluids and gels to pseudoplastic fluids. The release showed that the DS in the commercial injection (DS-inj) was completely liberated within 6 h, whereas only 46.55% and 49.73% of the DS in 2.5% cubic precursors and 2.5% hexagonal precursors were freed, respectively. Pharmacodynamic studies have shown that cubic, hexagonal and DS-inj raised the pain threshold in mice by 169.4%, 157.3% and 113.79%, respectively. The mean retention times of DS in cubic and hexagonal were 3.16 and 2.67 times longer than DS-inj, respectively, according to pharmacokinetic results. CONCLUSION In conclusion, cubic and hexagonal are both promising analgesic sustained release formulations. In addition, based only on the current comparison, cubic seems to have a better long-acting effect.
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Affiliation(s)
- Wenxuan Cao
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China
| | - Jingbao Chen
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China
| | - Long Wu
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China
| | - Yu Hang Xu
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China
| | - Yun Meng
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China
| | - Xiang Li
- Anhui Province Institute for Food and Drug Control, Hefei, Anhui, 230012, China
| | - Zhiyun Zheng
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; Institute of Pharmaceutics, Anhui Academy of Chinese Medicine, Hefei 230012, China; Anhui Province Key Laboratory of Pharmaceutical Preparation Technology and Application, Hefei, 230012, China; Engineering Technology Research Center of Modernized Pharmaceutics, Anhui Education Department (AUCM) , Hefei, Anhui, 230012, China
| | - Xiaoqin Chu
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; Institute of Pharmaceutics, Anhui Academy of Chinese Medicine, Hefei 230012, China; Anhui Province Key Laboratory of Pharmaceutical Preparation Technology and Application, Hefei, 230012, China; Engineering Technology Research Center of Modernized Pharmaceutics, Anhui Education Department (AUCM) , Hefei, Anhui, 230012, China.
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Wang Z, Feng D, Wei W. Impact of music on anxiety and pain control during extracorporeal shockwave lithotripsy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e23684. [PMID: 33530169 PMCID: PMC7850767 DOI: 10.1097/md.0000000000023684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/31/2020] [Accepted: 11/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The present evidence is insufficient for evaluating the impact of exclusive music therapy on anxiety and pain control in extracorporeal shock wave lithotripsy (ESWL). METHODS A systematic review and meta-analysis was conducted to explore the efficacy of music therapy in reducing pain and anxiety in patients undergoing ESWL. PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases (updated March 2020) were searched for randomized controlled trials assessing music therapy in reducing pain and anxiety in patients undergoing ESWL. The search strategy and study selection process were managed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. RESULTS Five randomized controlled trials were included in the meta-analysis. Overall, music intervention groups experienced significant reductions in pain (risk ratios = -1.20, 95% confidence intervals = -1.95 to -0.45, P = .002) and anxiety (risk ratios = -3.31, 95% confidence intervals = -4.97 to -1.84, P < .0001) compared with control groups during ESWL. Music therapy gave patient more satisfaction with the treatment and a willingness to repeat the therapy was reported. However, there was no significant difference in the stone clearance rate. CONCLUSIONS Listening to music can reduce patient's pain and anxiety significantly with increased therapy satisfaction and willingness to repeat.
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Le QT. Effectiveness in the Treatment of Intertrochanteric Fracture in Geriatric Patients by A Novel Prototype Carbon Composite External Fixator. Med Arch 2021; 75:122-132. [PMID: 34219872 PMCID: PMC8228569 DOI: 10.5455/medarh.2021.75.122-132] [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] [Indexed: 11/09/2022] Open
Abstract
Background: Intertrochanteric fracture is a common injury in seniors. Senior patients taking surgical interventions suffer from prolonged bed-rest complications such as pressure ulcer, thromboembolism, or pneumonia, which may lead to high mortality rate. A treatment using external fixators is, therefore, recommendable, and has shown satisfactory outcomes such as early weight-bearing, short hospitalization time and quick union time. Fracture treatments in Vietnam mainly use metal and imported fixation, raising concerns of compatibility and financial issues from patients. Objective: This study investigated the in vivo effectiveness in treating an intertrochanteric fracture in Vietnamese geriatric patients by a novel prototype carbon composite external fixator (whose shaft screws near the fracture site) and an available stainless steel external fixator (shaft screw far from the fracture site) already used in Vietnam. Methods: Fifty-five patients treated with the metal fixator and 54 patients treated with the composite fixator – all aged 60 – 99 – were monitored for treatment results until one year after surgery. Results: The results demonstrated the external fixator’s effectiveness, especially the composite prototype, which minimized blood loss, shortened operation time, reduced pain, and provided stable fixation that promoted proper bone union. Conclusion: The novel composite fixator prototype in this study was also superior to the current metal fixator in many aspects. Proper application of this method could prove its effectiveness in the surgical cure for fracture in older people. It should be a viable choice for intertrochanteric fracture treatment for senile people in Vietnam.
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Affiliation(s)
- Quang-Tri Le
- Department of Orthopedic, 7A Military Hospital, Ho Chi Minh City, Vietnam
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Çakıcı MÇ, Karakoyunlu N, Sari S, Ozok HU, Selmi V, Kartal IG, Nalbant I, Sagnak L, Ersoy H. Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy Used in the Treatment of 2–4 cm Kidney Stones in Terms of Pain and Need for Additional Analgesics: A Prospective Randomized Study. J Laparoendosc Adv Surg Tech A 2020; 30:1301-1307. [DOI: 10.1089/lap.2020.0179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Mehmet Çağlar Çakıcı
- Department of Urology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Nihat Karakoyunlu
- Department of Urology, Diskapi Yildirim Beyazit Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Sercan Sari
- Department of Urology, Bozok University School of Medicine, Yozgat, Turkey
| | - Hakki Ugur Ozok
- Department of Urology, Karabük University School of Medicine, Karabük, Turkey
| | - Volkan Selmi
- Department of Urology, Bozok University School of Medicine, Yozgat, Turkey
| | - Ibrahim Guven Kartal
- Department of Urology, Diskapi Yildirim Beyazit Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Ismail Nalbant
- Department of Urology, Lokman Hekim Etlik Hospital, Ankara, Turkey
| | - Levent Sagnak
- Department of Urology, Diskapi Yildirim Beyazit Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Hamit Ersoy
- Department of Urology, Diskapi Yildirim Beyazit Education and Research Hospital, Health Sciences University, Ankara, Turkey
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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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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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The use of diclofenac sodium in urological practice: A structural and neurochemical based review. J Chem Neuroanat 2018; 87:32-36. [DOI: 10.1016/j.jchemneu.2017.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/02/2017] [Accepted: 02/04/2017] [Indexed: 11/23/2022]
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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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