Patient controlled analgesia for extracorporeal shock wave lithotripsy of gallstones

Abstract

Sixty patients undergoing shock wave lithotripsy of gallbladder stones (ESWL) were randomly assigned to receive alfentanil either by infusion controlled by the attending anesthesiologist (standard treatment group, n = 31) or by analgesia controlled by the patient (PCA group, n = 29). Patients using PCA were allowed to self-administer 0.25 mg of alfentanil i.v. every minute as required. Data collected during treatment included the total dose of drug required, transcutaneous pCO2 values, verbal pain and sedation scores, visual analogue scale (VAS) patient satisfaction scores, and the incidence of nausea or vomiting. PCA patients used less alfentanil than the standard treatment group (PCA group: 12.8 micrograms/kg; standard treatment group: 44.3 micrograms/kg; mean values, P = 0.0001), tolerated significantly higher pain intensities and self-administered the narcotic only to moderate levels of pain but not to pronounced analgesia. Standard treatment patients reported lower levels of pain, were more sedated (P less than 0.05) and showed significantly higher transcutaneous pCO2 values. There was a trend towards a lower incidence of nausea or vomiting in PCA patients without reaching statistical significance. No significant difference with regard to patient satisfaction with pain relief could be demonstrated. Self-administered alfentanil during ESWL of gallbladder stones provided adequate analgesia with minimal side effects and high patient satisfaction. ESWL may represent a new and useful indication for PCA.

Randomised double‐blind comparison of morphine vs. a morphine–alfentanil combination for patient‐controlled analgesia

“…This is consistent with alfentanil's rapid penetration of the blood-brain barrier, which is related to its high un-ionised fraction at physiological pH [2]. The use of alfentanil for PCA has been described previously, both for postoperative analgesia [5,8] and for analgesia during procedures such as wound dressing changes [9], extracorporeal shock-wave lithotripsy [10,11] and bone-marrow harvesting [12]. The rapid onset of alfentanil is particularly useful for procedure-related analgesia, when pain occurs at predictable times and is of relatively short duration.…”

“…The rapid onset of alfentanil is particularly useful for procedure-related analgesia, when pain occurs at predictable times and is of relatively short duration. In these situations, PCA with alfentanil has been described both with [12] and without [10,11] a concurrent infusion. In comparison, postoperative pain is generally more constant and of longer duration and, because the duration of action of alfentanil is very short, a concurrent infusion may be necessary for optimum analgesia [5,8].…”

Use of traditional Chinese medicine in the management of urinary stone disease

“…Eighty hertz were used in TENS group. Shockwave energy was estimated by an index described by Schelling et al, which considers both voltage and number of shocks (44). During the operation, patients were oriented to utilize the PCA button whenever the VAS > 3.…”

Patient maintained alfentanil target-controlled infusion for analgesia during extracorporeal shock wave lithotripsy

“…6-9 Various modes of administration have been tried including physician titrated infusion, 7,8 and PCA bolus dosing. 9 We have evaluated a new technique of pharmacokinetic-based infusion of alfentanil where the target plasma concentration of the drug is maintained by patient demand.…”