Choudhary A. et al., 2019: A novel triple oral regime provides effective analgesia during extracorporeal shockwave lithotripsy for renal stones
Choudhary A, Basu S, Sharma R, Gupta R, Das RK, Dey RK.
Department of Urology, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India.
Department of Urology, Apex Hospital, Jaipur, Rajasthan, India.
Context: Analgesia during extracorporeal shockwave lithotripsy for renal stone is an essential component. It not only makes the procedure comfortable but also increases the stone-free rate. Aims: The aim of this study was to evaluate the efficacy of triple oral analgesic agents on stone fragmentation and pain relief in comparison to injectable analgesic agents. Settings and Design: This prospective randomized study included 68 patients of renal calculi of size 5-15 mm. Subjects and Methods: Group A had 32 patients, who received injection pentazocine and injection diclofenac, 45 min before the procedure. Group B consisted of 28 patients, who received a combination of oral acetaminophen, 325 mg, oral diclofenac 50 mg, and oral tramadol 37.5 mg, 45 min prior. Procedural findings, pain score visual analog scale (VAS), fragmentation rate, and outcome were recorded. Statistical Analysis Used: Independent t-test and Pearson's correlation test. Results: A total of 60 patients were analyzed. The mean age was 40.2 ± 11.8 years. Both groups were comparable in body mass index, stone size, number, and density. Group A required more shocks than Group B (4274 vs. 3693, P = 0.043). A lower energy level of shocks (kV) was tolerated in Group A (2.5 vs. 3.2, P = 0.002). Group A required more sittings than Group B (2.3 vs. 1.9, P = 0.037). VAS score was significantly less in Group B (2.9 vs. 4.9, P = 0.0001). The overall fragmentation rate was similar among groups (81.2% vs. 89.3%); hence, the successful outcome was (59.4% vs. 75.0%, P = 0.274). The occurrence of adverse events was also equivalent in both groups (P = 0.199). Conclusions: Triple oral regime provides better analgesic effect and quicker stone-free rate than injectable agents but with similar final outcome.
Urol Ann. 2019 Jan-Mar;11(1):66-71. doi: 10.4103/UA.UA_15_18.
“Fragmentation was classified into complete ( 4-mm fragments), partial (4-mm fragments), and no fragmentation.”
“Success was defined by either complete clearance of stone or clinically insignificant residual fragments of 4 mm size, 4 weeks after the session.”
Good study. It obviously compared the traditional protocol against a new protocol. Difficult to imagine that insufficient analgesia with poor results could be or was part of a routine treatment.