Randomized Comparison of Efficacy of Paracetamol, Lornoxicam, and Tramadol Representing Three Different Groups of Analgesics for Pain Control in Extracorporeal Shockwave Lithotripsy

Akcali, Gulgun Elif; Iskender, Abdülkadir; Demiraran, Yavuz; Kayikci, Ali; Yalcın, Gulbin Sezen; Çam, Kamil; Balcıoğlu, Y. Okan

doi:10.1089/end.2009.0483

Cited by 26 publications

(39 citation statements)

References 19 publications

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“…Our assessment identified 9 studies that involved 539 participants (from 6 countries) which were available for inclusion dating from years 1992 to 2010 (25-33). One of these studies had multiple treatment arms (25).…”

Section: Included Studiesmentioning

confidence: 99%

“…One of these studies had multiple treatment arms (25). Trial agents included seven types of NSAIDs (lornoxicam, piroxicam, diclofeanc, keterolac, parecoxib, indomethacin and dexketoprofen), one simple analgesic (paracetamol) and five types of opioids (tramadol, remifentanil, fentanyl and morphine and pethidine).…”

Section: Included Studiesmentioning

confidence: 99%

“…There is a high risk of selection bias as only two studies (25, 27) mention a robust method of random sequence generation with the remainder not mentioning in sufficient detail to assess methodological quality in this domain. Regarding allocation, only one trial (30) described a method of randomisation which gave sufficient allocation concealment where central allocation was used.…”

Section: Allocation (Selection Bias)mentioning

confidence: 99%

“…In four studies (25, 30, 32, 33), participants and personnel were blinded to reduce performance bias. In three studies (26, 27, 29), participants alone were blinded.…”

Section: Blinding (Performance Bias and Detection Bias)mentioning

confidence: 99%

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Analgesia for patients undergoing shockwave lithotripsy for urinary stones – a systematic review and meta-analysis

et al. 2017

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Background Shock wave lithotripsy (SWL) is the first line treatment modality for a significant proportion of patients with upper urinary tracts stones. Simple analgesics, opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are all suitable agents but the relative efficacy and tolerability of these agents is uncertain.Objectives To determine the efficacy of the different types of analgesics used for the control of pain during SWL for urinary stones.Materials and Methods We searched the Cochrane Renal Group’s Specialised Register, MEDLINE, EMBASE and also hand-searched reference lists of relevant articles (Figure-1). Randomised controlled trials (RCT’s) comparing the use of any opioid, simple analgesic or NSAID during SWL were included. These were compared with themselves, each-other or placebo. We included any route or form of administration (bolus, PCA). We excluded agents that were used for their sedative qualities. Data were extracted and assessed for quality independently by three reviewers. Meta-analyses have been performed where possible. When not possible, descriptive analyses of variables were performed. Dichotomous outcomes are reported as relative risk (RR) and measurements on continuous scales are reported as weighted mean differences (WMD) with 95% confidence intervals.Results Overall, we included 9 RCTs (539 participants from 6 countries). Trial agents included 7 types of NSAIDs, 1 simple analgesic and 4 types of opioids. There were no significant differences in clinical efficacy or tolerability between a simple analgesic (paracetamol) and an NSAID (lornoxicam). When comparing the same simple analgesic with an opioid (tramadol), both agents provided safe and effective analgesia for the purpose of SWL with no significant differences. There were no significant differences in pain scores between NSAIDs or opioids in three studies. Adequate analgesia could be achieved more often for opioids than for NSAIDs (RR 0.358; 95% CI 043 to 0.77, P=0.0002) but consumed doses of rescue analgesia were similar between NSAIDs and opioids in two studies (P=0.58, >0.05). In terms of tolerability, there is no difference in post-operative nausea and vomiting (PONV) between the groups (RR 0.72, 95% CI 0.24 to 2.17, P=0.55). One study compared outcomes between two types of NSAIDs (diclofenac versus dexketoprofen). There were no significant differences in any of our pre-defined outcomes measures.Conclusion Simple analgesics, NSAIDs and opioids can all reduce the pain associated with shock wave lithotripsy to a level where the procedure is tolerated. Whilst there are no compelling differences in safety or efficacy of simple analgesics and NSAIDs, analgesia is described as adequate more often for opioids than NSAIDs.

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Section: Included Studiesmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

Section: Allocation (Selection Bias)mentioning

confidence: 99%

“…In four studies (25, 30, 32, 33), participants and personnel were blinded to reduce performance bias. In three studies (26, 27, 29), participants alone were blinded.…”

Section: Blinding (Performance Bias and Detection Bias)mentioning

confidence: 99%

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Analgesia for patients undergoing shockwave lithotripsy for urinary stones – a systematic review and meta-analysis

et al. 2017

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“…Its short half-elimination time (4 hours regardless of the drug concentration) makes side effects less significant, because during the period between drug administration the renewal of physiological levels of prostaglandins required for protection of the gastric mucosa from the damage takes its place. Xefocam is recommended for treatment of extreme and chronic inflammatory states and associated pathological processes and pain [10].…”

mentioning

confidence: 99%

The study of the effect of substance L486-0021 on the course of the experimental pulmonary edema in rats

et al. 2015

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Adults with Conditions Causing Chronic Pain

Thornton

Southerland

2011

Challenging and Emerging Conditions in Emergency Medicine

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Randomized Comparison of Efficacy of Paracetamol, Lornoxicam, and Tramadol Representing Three Different Groups of Analgesics for Pain Control in Extracorporeal Shockwave Lithotripsy

Abstract: This study suggests that paracetamol, lornoxicam, and tramadol can be safely and efficiently preferred in pain control during SWL.

Cited by 26 publications

References 19 publications

Analgesia for patients undergoing shockwave lithotripsy for urinary stones – a systematic review and meta-analysis

Analgesia for patients undergoing shockwave lithotripsy for urinary stones – a systematic review and meta-analysis

The study of the effect of substance L486-0021 on the course of the experimental pulmonary edema in rats

Adults with Conditions Causing Chronic Pain

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