Comparison of Three Analgesic Treatment Protocols for Pain Management during Extracorporeal Shock Wave Lithotripsy

Eryıldırım, Bilal; Kuyumcuoğlu, Uğur; Tarhan, Fatih; Faydaci, Gokhan; Uruç, Fatih

doi:10.1159/000209357

Cited by 11 publications

(4 citation statements)

References 32 publications

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“…The analgesic effect of EMLA cream is much less than intramuscular Sodium Diclofenac and their mixture has no superiority over using Sodium Diclofenac alon. 24 The operators were quite satisfied of the results of the diclofenac group, since only 3.7% of the patients in this group felt severe pain. Furthermore, more than 40% of participants in the placebo group felt a severe pain, requiring venous drugs.…”

Section: Resultsmentioning

confidence: 87%

Enteral diclofenac controls pain and reduces intravenous injection during extracorporeal shock wave lithotripsy

et al. 2018

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Urinary system stones are the third most common disease of urinary system following urinary infection and prostate pathology. Extracorporeal shockwave lithotripsy (ESWL) is one of the methods used to treat Urolithiasis where shockwaves are transmitted through skin and body organs and crush the stones into small pieces. This is a painful procedure which usually requires analgesics. Each analgesic drug has its own advantages and disadvantages. The present research seeks to study the effectiveness of using diclofenac suppository in order to control pain and reduce need for venous drugs during ESWL procedure. This is a double blind clinical trial. 158 patients resorting to Shahid Hasheminezhad Specialized Center for ESWL were randomly selected to take part in this projects with due consideration of inclusion criteria. The patients were equally divided into the S (diclofenac suppository) and A (placebo) groups. 2 diclofenac suppositories were used in the S group 20 minutes prior to beginning ESWL. Then, ESWL was carried out in supine position using fluoroscopic conduction with standard method. The present research has studied pain scale of patients, operator’s and patient’s satisfaction during the operation and patient’s hemodynamic parameters in three phases prior to, during, and after ESWL. SPSS v.17 was used to study the data and Chi-Square Tests and Repeated Measure ANOVA were used to analyze the results. The level of significance in the present research was set to P-value < 0.05.A review of pain scales across both groups showed that using diclofenac suppository has a significant influence in reducing the pain scale and, hence, need for venous drugs (P-value < 0.05). No significant difference was observed between the two groups in terms of heart beat and blood pressure changes in various times (P-value > 0.05). The results also report different satisfaction levels for patients and operators across the two groups (diclofenac suppository and placebo) (P-value < 0.05). Higher satisfaction levels were observed among both patients and operators in the group receiving diclofenac suppository. A general look at the data yields the conclusion that receiving pain killers (diclofenac suppository) before starting ESWL plays a more efficient role in reducing pain scales of patients and enhancing operators’ satisfaction..

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Section: Resultsmentioning

confidence: 87%

Enteral diclofenac controls pain and reduces intravenous injection during extracorporeal shock wave lithotripsy

et al. 2018

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“…These studies provide a wide array of options for analgesia during ESWL including intravenous, intramuscular, gel, local infiltration, and oral agents. [10111213141516] Their reported efficacy varies a lot among the studies. Our choice of triple oral agents was based on their proven individual efficacy in injectable forms, along with the oral formulation being more comfortable for all patients.…”

Section: Discussionmentioning

confidence: 99%

A novel triple oral regime provides effective analgesia during extracorporeal shockwave lithotripsy for renal stones

et al. 2019

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Context:Analgesia during extracorporeal shockwave lithotripsy for renal stone is an essential component. It not only makes the procedure comfortable but also increases the stone-free rate.Aims:The aim of this study was to evaluate the efficacy of triple oral analgesic agents on stone fragmentation and pain relief in comparison to injectable analgesic agents.Settings and Design:This prospective randomized study included 68 patients of renal calculi of size 5–15 mm.Subjects and Methods:Group A had 32 patients, who received injection pentazocine and injection diclofenac, 45 min before the procedure. Group B consisted of 28 patients, who received a combination of oral acetaminophen, 325 mg, oral diclofenac 50 mg, and oral tramadol 37.5 mg, 45 min prior. Procedural findings, pain score visual analog scale (VAS), fragmentation rate, and outcome were recorded.Statistical Analysis Used:Independent t-test and Pearson's correlation test.Results:A total of 60 patients were analyzed. The mean age was 40.2 ± 11.8 years. Both groups were comparable in body mass index, stone size, number, and density. Group A required more shocks than Group B (4274 vs. 3693, P = 0.043). A lower energy level of shocks (kV) was tolerated in Group A (2.5 vs. 3.2, P = 0.002). Group A required more sittings than Group B (2.3 vs. 1.9, P = 0.037). VAS score was significantly less in Group B (2.9 vs. 4.9, P = 0.0001). The overall fragmentation rate was similar among groups (81.2% vs. 89.3%); hence, the successful outcome was (59.4% vs. 75.0%, P = 0.274). The occurrence of adverse events was also equivalent in both groups (P = 0.199).Conclusions:Triple oral regime provides better analgesic effect and quicker stone-free rate than injectable agents but with similar final outcome.

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“…aussi, dans leur analyse portée sur 120 patients parue en 2009, ont comparé l'effet analgésique lors de la LEC de la crème EMLA ® seule, du Diclofenac seul et de leur association. Ils ont montré aucune différence, dans le contrôle de la douleur, chez les patients recevant du Diclofenac avec ou sans crème, et l'effet supérieur du Diclofenac sur EMLA [20]. Néanmoins, ces études sont relativement anciennes, utilisant des lithotripteurs de première ou seconde générations et comparant un nombre réduit de patients.…”

Section: Discussionunclassified

Evaluation des protocoles analgésiques pour la prise en charge de la douleur au cours de la lithotripsie extra corporelle

Daly¹,

Chaker²,

Rhouma³

et al. 2019

Pan Afr Med J

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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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Comparison of Three Analgesic Treatment Protocols for Pain Management during Extracorporeal Shock Wave Lithotripsy

Cited by 11 publications

References 32 publications

Enteral diclofenac controls pain and reduces intravenous injection during extracorporeal shock wave lithotripsy

Enteral diclofenac controls pain and reduces intravenous injection during extracorporeal shock wave lithotripsy

A novel triple oral regime provides effective analgesia during extracorporeal shockwave lithotripsy for renal stones

Evaluation des protocoles analgésiques pour la prise en charge de la douleur au cours de la lithotripsie extra corporelle

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