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Demir A et al, 2015: Pain control using pethidine in combination with diazepam compared to diclofenac in combination with hyoscine-n-butyl bromide: in patients undergoing extracorporeal shock wave lithotripsy.

Demir A, Cecen K, Karadag MA, Uslu M, Arslan OE.
Kafkas University, Medical School, Department of Urology, Kars, Turkey.

Abstract

INTRODUCTION: Extracorporeal Shock Wave Lithotripsy (ESWL) remains the preferred least invasive treatment for urinary tract stones. The main purpose of this study was to compare two treatment modalities for pain control during the ESWL procedure.
MATERIAL AND METHODS: From 2013 to 2014, 220 patients received ESWL for kidney stones. Before the procedure, the weight and height were measured to determine the body mass index (BMI); in addition, oxygen saturation and the pulse of the patients, as well as pain level were determined. The pain control provided included two different methods: diclofenac sodium plus hyoscine-N-butyl bromide in the first group and pethidine plus diazepam in the second group. The pain level of the patients was determined using two different scales: the Wong-Baker and the Visual Analogue scales (VAS). At the end of three sessions, all patients were evaluated for the stone fragmentation rate by plain abdominal X-ray, and the findings were recorded and analyzed.
RESULTS: A total of 220 patients were enrolled in this study. There were 91 patients in the first group (diclofenac sodium + hyoscine-N-butyl bromide) (male/female: 63/28) and 129 (male/female: 83/46) patients in the second group (pethidine HCL +diazepam). The mean age with SD according to each group was 42.03 (±16.43) and 42.56 (±14.23), respectively (p = 0.8). With regard to pain scores (using the Wong-Baker and VAS scales), the responses were significantly lower in the second group (p <0.001).
CONCLUSIONS: Pethidine in combination with diazepam was superior to diclofenac and Hyoscine-N-butyl bromide for pain in patients undergoing ESWL.

Cent European J Urol. 2015;68(2):201-6. doi: 10.5173/ceju.2015.479. Epub 2015 May 4 

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Comments 1

Hans-Göran Tiselius on Friday, 18 December 2015 10:57

It is important to note that effective stone disintegration is painful and that it is necessary to administer effective analgesics. It is the course of the procedure and not the reaction by the patient that should determine the treatment strategy [1].

In this report the authors compared the effect of two combinations of drugs. A. Diclofenac +hyoscine-n-butyl bromide (that is Buscopan ™) and B. Pethidine and diazepam. Not unexpectedly alternative B had the best effect and whereas 9% of the patients treated with regimen A did not tolerate the treatment, all patients given regimen B completed the SWL procedure.

I have personally and successfully used combination B in a large number of patients during many years. The only drawback is the long sedative duration. Therefore, in my own hands, the intermittent administration of alfentanyl and propofol was an even better regimen because of the rapid elimination of the two drugs [2].

Whichever method that is chosen, it is recommended with oxygen supply on mask or nose catheter and, as the authors have made, to measure the oxygen saturation.

The Wong-Baker scale for pain evaluation seems to be an attractive tool.

References
1. Tiselius HG,Chaussy CG (2012) Aspects on how extracorporeal shockwave lithotripsy should be carried out in order to be maximally effective. Urological Research 40: 433-446.
2. Tiselius HG (2008) How efficient is extracorporeal lithotripsy with modern lithotripters for removal of ureteral stones? Journal of Endourology 22: 249-255.

It is important to note that effective stone disintegration is painful and that it is necessary to administer effective analgesics. It is the course of the procedure and not the reaction by the patient that should determine the treatment strategy [1]. In this report the authors compared the effect of two combinations of drugs. A. Diclofenac +hyoscine-n-butyl bromide (that is Buscopan ™) and B. Pethidine and diazepam. Not unexpectedly alternative B had the best effect and whereas 9% of the patients treated with regimen A did not tolerate the treatment, all patients given regimen B completed the SWL procedure. I have personally and successfully used combination B in a large number of patients during many years. The only drawback is the long sedative duration. Therefore, in my own hands, the intermittent administration of alfentanyl and propofol was an even better regimen because of the rapid elimination of the two drugs [2]. Whichever method that is chosen, it is recommended with oxygen supply on mask or nose catheter and, as the authors have made, to measure the oxygen saturation. The Wong-Baker scale for pain evaluation seems to be an attractive tool. References 1. Tiselius HG,Chaussy CG (2012) Aspects on how extracorporeal shockwave lithotripsy should be carried out in order to be maximally effective. Urological Research 40: 433-446. 2. Tiselius HG (2008) How efficient is extracorporeal lithotripsy with modern lithotripters for removal of ureteral stones? Journal of Endourology 22: 249-255.
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