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Yesil S et al, 2015: Effect of different analgesics on pain relief during extracorporeal shock wave lithotripsy.

Yesil S, Polat F, Ozturk U, Dede O, Imamoglu M, Bozkirli I
Department of Urology, Faculty of Medicine, Gazi University, Besevler, Turkey
Department of Urology, Diskapi Yildirim Beyazit Training and Research Hospital, Dişkapi, Ankara, Turkey

Abstract

BACKGROUND/AIM: The aim of this study was to compare three drugs for pain relief during shock wave lithotripsy (SWL).
MATERIALS AND METHODS: Seventy six male patients that were treated for renal stones with SWL were included in this study. They were randomized into four groups. A different treatment protocol was used for each group. Intramuscular (IM) diclofenac 75mg was given in group 1 (n=20), dexketoprofen, 50mg, IM in group 2 (n=20) and hyoscine 10 mg plus paracetamol 500mg, orally in group 3 (n=20). In group 4 (control, n=16) saline solution was given 30 min before SWL. Pain during SWL was assessed using the 10-score linear visual analogue pain scale (VAS) and was compared among groups. Age, weight, height, body mass index (BMI), stone size, stone location, duration of SWL, total shock waves performed and mean energy level (kV) for each patient were recorded. A p value of <0.05 was considered statistically significant. RESULTS: The mean patients' age was 45.4 ± 12.9 years. The highest VAS value was observed in Group 4 (8.4 ± 1), and the lowest in Group 1 (6.25 ± 2.2). Statistically significant difference was noted only when Group 1 and Group 4 were compared. The remaining groups provided similar results and there were no significant statistical differences according to VAS values. Other parameters were similar in all groups.
CONCLUSION: In conclusion, this study shows that reducing the pain with a single dose injection of intramuscular diclofenac sodium before SWL is superior compared to others. 

Hippokratia. 2014 Apr;18(2):107-9.

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Comments 1

Peter Alken on Monday, 16 March 2015 11:00

The authors mention a serious problem of the study design:
“ Though mixture of hyoscine-N-butyl bromide plus paracetamol, which is used for SWL-related pain for the first time in the literature reduces VAS scores, its ananlgesic effect seems to be less compared with diclofenac. This is because reaching a peak concentration of paracetamol in this combination takes twice time compared to dexketoprofen and diclofenac (the former 30- 60 minutes, the latter 28-30 minutes). If hyoscine-N-butyl bromide plus paracetamol had been given an hour instead of half an hour before SWL operation, it might have been better than dexketoprofen and diclofenac. For this reason, the present results should be supported with future studies.”

The authors mention a serious problem of the study design: “ Though mixture of hyoscine-N-butyl bromide plus paracetamol, which is used for SWL-related pain for the first time in the literature reduces VAS scores, its ananlgesic effect seems to be less compared with diclofenac. This is because reaching a peak concentration of paracetamol in this combination takes twice time compared to dexketoprofen and diclofenac (the former 30- 60 minutes, the latter 28-30 minutes). If hyoscine-N-butyl bromide plus paracetamol had been given an hour instead of half an hour before SWL operation, it might have been better than dexketoprofen and diclofenac. For this reason, the present results should be supported with future studies.”
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