Topical EMLA for pain control during extracorporeal shock wave lithotripsy: prospective, comparative, randomized, double-blind study

Abstract

Patient collaboration in external shock wave lithotripsy (ESWL) is critical for its correct application, making proper analgesic selection indispensable. The aim of this study was to evaluate the efficacy of combined application of EMLA and intravenous (i.v.) pethidine compared with pethidine plus placebo cream in patients undergoing ESWL for ureteral and/or renal lithiasis. Prospective, controlled, randomized, double-blind study was conducted in patients receiving ESWL for renal and/or ureterolithiasis. The patients were randomly assigned to receive i.v. pethidine plus either EMLA cream (group A) or placebo hydrating cream (group B). Evaluated were type, location, and size of lithiasis, patient's sex, age, body mass index, comorbidity, Visual Analogue Scale (VAS) score of pain, and degree of lithiasis fragmentation. EMLA cream provided significantly better pain relief and lithiasis fragmentation and more completed ESWL treatment. Topical application of EMLA cream combined with i.v. pethidine improved VAS scores and lithiasis fragmentation and decreased the rate of withdrawal from ESWL procedure versus i.v. pethidine plus placebo therapy.

Eutectic mixture of local anaesthetics for pain reduction during extracorporeal shockwave lithotripsy: A systematic review and meta-analysis

“…A sensitivity analysis was performed to evaluate the stability of the results due to a significant heterogeneity in the primary outcome among studies. After removing one study at a time, we found that the heterogeneity was mainly caused by Vilar et al [17]. After removing this study, the pain reduction effect by EMLA became insignificant (RR = -1.30, 95% CI = -3.25 to -0.65, P = 0.19) with a low heterogeneity of I 2 = 4% (P = 0.38, Fig 3).…”

“…An additional explanation could be that a cream-skin interface has less absorption and reflection of energy, leading to less skin trauma and pain. On the other hand, this interface also brings more energy transmission to the stones, which results in a lower numbers of required shock waves and total energy as demonstrated by Vilar et al [17,24]. Accordingly, the authors found better stone fragmentation in the EMLA-treated group.…”

“…We also excluded from our analysis: one article for its study design (not RCT), one articles for insufficient data, and one article for inconformity of outcomes. Finally, six RCTs that satisfied the inclusion criteria were enrolled in this meta-analysis [9,[13][14][15][16][17]. The article selection process followed the PRISMA statement (Fig 1).…”

“…Acar et al used remifentanil as the intraoperative analgesics [9]. Finally, Vilar et al and Tritrakarn et al did not supply their patients with any pain medication [16,17]. Jadad scores of the included studies ranged from 4 to 5, thus were regarded as high-quality RCTs.…”

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

“…Vilar, et al, in their analysis, used intravenous pethidine and EMLA cream in one group and intravenous pethidine and placebo cream in another group for pain control during ESWL. They concluded that EMLA cream combined with intravenous pethidine improved the visual analogue score, stone fragmentation, and decreased rate of withdrawal from ESWL procedure versus intravenous pethidine and placebo cream [15]. Similarly, Kumar, et al showed improved pain control and better stone-free rate with topical EMLA cream in combination with diclofenac sodium as compared to either of the entities used alone [16].…”