Bach C et al, 2011: Drugs for pain management in shock wave lithotripsy
Bach C, Zaman F, Kachrilas S, Kumar P, Buchholz N, Masood J
Department of Urology, Barts and The London NHS Trust, West Smithfield, London EC1A 7BE, UK
Objective. With this review, we provide a comprehensive overview of the main aspects and currently used drugs for analgesia in shockwave lithotripsy. Evidence Acquisition. We reviewed current literature, concentrating on newer articles and high-quality reviews in international journals. Results. No standardized protocols for pain control in SWL exist, although it is crucial for treatment outcome. General and spinal anaesthesia show excellent pain control but are only recommended for selected cases. The newer opioids and nonsteroidal anti-inflammatory drugs are able to deliver good analgesia. Interest in inhalation anaesthesia with nitrous oxide, local anaesthesia with deep infiltration of the tissue, and dermal anaesthesia with EMLA or DMSO has recently rekindled, showing good results in terms of pain control and a favourable side effect profile. Tamsulosin and paracetamol are further well-known drugs being currently investigated. Conclusion. Apart from classically used drugs like opioids and NSARs, medicaments like nitrous oxide, paracetamol, DMSA, or refined administration techniques for infiltration anaesthesia show a good effectiveness in pain control for SWL.
Pain Res Treat. 2011;2011:259426. doi: 10.1155/2011/259426. Epub 2011 Nov 3
PMID:22135735[PubMed - in process] PMCID:PMC3216367
This is a timely review on an important aspect of SWL at a time when "re-education" of shock wave users becomes popular to improve treatment results.