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

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

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.

A Novel Molecular Reservoir Based on Reverse Self-Assembled Liquid Crystals - A New Strategy for Prolonging the Duration in Action of Analgesics

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.

Impact of music on anxiety and pain control during extracorporeal shockwave lithotripsy: A protocol for systematic review and meta-analysis

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.

Effectiveness in the Treatment of Intertrochanteric Fracture in Geriatric Patients by A Novel Prototype Carbon Composite External Fixator

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.

Strategies to maximise patient comfort during extracorporeal shockwave lithotripsy - A randomised controlled trial

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).

[Evaluation of protocols on the use of analgesics for pain management in patients with extracorporeal shock wave lithotripsy (ESWL)]

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.

Comparison of Different Analgesia Drug Regimens for Pain Control During Extracorporeal Shock Wave Lithotripsy for Renal Stones: A Randomized Control Study

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.