Abstract

Abstract

Abstract   Background and Purpose: Lithotripsy is an established method to fragment kidney stones that can be performed without general anesthesia in the outpatient setting. Discomfort and/or noise, however, may deter some patients. It has been demonstrated that audiovisual distraction (AV) can reduce sedoanalgesic requirements and improve patient satisfaction in nonurologic settings, but to our knowledge, this has not been investigated with lithotripsy. This randomized controlled trial was designed to test the hypothesis that AV distraction can reduce perceived pain during lithotripsy.   Patients and Methods: All patients in the study received identical analgesia before a complete session of lithotripsy on a fixed-site Storz Modulith SLX F2 lithotripter. Patients were randomized to two groups: One group (n=61) received AV distraction via a wall-mounted 32″ (82 cm) television with wireless headphones; the other group (n=57) received no AV distraction. The mean intensity of treatment was comparable in both groups. Patients used a visual analogue scale (0-10) to record independent pain and distress scores and a nonverbal pain score was documented by the radiographer during the procedure (0-4).   Results: In the group that received AV distraction, all measures of pain perception were statistically lower. The patient-reported pain score was reduced from a mean of 6.1 to 2.4 (P<0.0001), and the distress score was reduced from a mean of 4.4 to 1.0 (P=0.0001). The mean nonverbal score recorded by the radiographer was reduced from 1.5 to 0.5 (<0.0001).   Conclusions: AV distraction significantly lowered patients' reported pain and distress scores. This correlated with the nonverbal scores reported by the radiographer. We conclude that AV distraction is a simple method of improving acceptance of lithotripsy and optimizing treatment.

J Endourol. 2012 May;26(5):531-4. doi: 10.1089/end.2011.0430. Epub  2012 Feb 8

PMID:22098167[PubMed - as supplied by publisher]

Comment

Comment

This paper is a surprise and should be read by those who read the paper No. 5. in this review  by Bach C, Zaman F, Kachrilas S, Kumar P, Buchholz N, Masood J. Drugs for pain management in shock wave lithotripsy. Pain Res Treat. 2011;2011:259426.

Unfortunately the authors did not mention the title or topics of the “30 different DVDs of 30-minute television programs were given to the patient before the procedure allowing DVD selection to suit different patient’s age/sex/personality.”

The effect was impressive by reducing the patients pain perception scores from moderate/severe (6) to slight/mild (2).

Peter Alken