Comparison of Different Analgesic Techniques for Pain Relief During Extracorporeal Shock Wave Lithotripsy: a Double-blind, Randomized Clinical Trial

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.

Remifentanil-induced postoperative hyperalgesia: current perspectives on mechanisms and therapeutic strategies

“…Remifentanil administration by target-controlled infusion is effective and safe in the reduction of pain intensity during ambulatory procedure (ie, extracorporeal lithotripsy). 10 Sedation with remifentanil has shown some advantages over dexmedetomidine during flexible bronchoscopy, resulting in a shorter time to recovery. 11 In a population of children undergoing bone marrow aspiration, remifentanil offered analgesic advantages over alfentanil during the procedure.…”

Ultrasound-guided Paravertebral Block Versus Intravenous Sedative Analgesic using Midazolam /Fentanyl in Patients Undergoing Extracorporeal Shock Wave Lithotripsy

“…The extracorporeal shock wave lithotripsy (ESWL) is a common method for treatment of the urinary tract stones with fewer complications than other invasive procedures [1]. Most patients experience some degree of pain during this procedure [2,3]. Clinical outcomes and success as measured in terms of stone-free rate after ESWL is strongly correlated to pain experienced during treatment [4].…”

“…Many drugs and methods such as local anesthetic infiltration, intravenous (IV) or oral non steroidal anti inflammatory drugs and opioid agents have been used for pain management during ESWL [2]. Nonetheless, the most effective analgesic regimen during ESWL has not been determined [2,3].…”

“…Many drugs and methods such as local anesthetic infiltration, intravenous (IV) or oral non steroidal anti inflammatory drugs and opioid agents have been used for pain management during ESWL [2]. Nonetheless, the most effective analgesic regimen during ESWL has not been determined [2,3]. Among the drugs that were used for analgesia during ESWL, opioids seem to be a favorable analgesic; however the opioid administration may be problematic especially at high doses in an outpatient setting, due to a longer recovery time and side effects like nausea, hypotension, respiratory depression and vomiting [5].…”