El-Khoury HJ. et al., 2019: Impact of modern media on analgesic requirements during extracorporeal shockwave lithotripsy
El-Khoury HJ, Brookes JDL, Tan B, Shahbaz S, McCahy PJ.
Department of Urology, Casey Hospital, Monash Health, Melbourne, Victoria, Australia.
School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.
In Australia, shockwave lithotripsy (SWL) to treat urinary tract stones is routinely performed with general anaesthesia (GA). We have established a SWL service avoiding GA based outside operating theatres and wish to assess the effectiveness of utilizing modern media on patient satisfaction and analgesic requirements during treatment.
A randomized three-arm trial was performed. Patients were allocated to either watching videos or listening to music on a tablet device, or to getting no media distraction. A total of 95 patients were recruited in a 1:1:1 fashion. Analgesic requirements were recorded during the procedure and patients were asked to fill out a questionnaire with a visual analogue scale to assess their overall pain and satisfaction with the procedure.
Overall pain scores were decreased - the sound media group reported a mean pain score of 3.52 (P = 0.005), the visual group was 3.62 (P = 0.007), compared to 5.45 in the control group. Analgesic requirements were significantly decreased when compared to the control group (P = 0.05). Overall satisfaction with the procedure was improved in the treatment groups, with the sound group having the best result (P = 0.04).
Modern media can be used as a distraction during SWL in a safe and effective way when treating renal tract stones without GA. Analgesic requirements are decreased significantly, therefore decreasing any potential side-effects and complications. Other departments in Australia should consider using this technique.
ANZ J Surg. 2019 Sep 30. doi: 10.1111/ans.15446. [Epub ahead of print]
All patients got the standard medication: ”Our standard pre-treatment analgesia of a non-steroidal anti-inflammatory drug suppository was offered to all patients and any breakthrough pain was treated with IM fentanyl.”
“An additional IM opiate was required during treatment in 20% of the sound group and 27% of the vision group compared to 42% in the control group (P-value 0.05) (Fig. 4).”
Good, straight forward randomized study with easy to apply clinical consequences: ”Media was delivered through an Apple iPad attached to the lithotripsy machine using a modified tablet holder (Fig. 1) with noise-cancelling headphones”
One additional comment to the Methods section:
“There were 73 males and 22 females, with most patients being of either Caucasian or European descent.”
Decades ago I read an American urological paper and had to look up what a Caucasian is. I found out that I was such a - white - human being even though I was surprised to eventually have my roots in this area:
Since many years I understood that we are not “Caucasians” but we are all a genetic mixture.
Now after having read the present urological paper I might be of “European descent”.
I like to be stimulated to think outside the box and recommend others to read https://en.wikipedia.org/wiki/Caucasian_race
William Shakespeare, The Merchant of Venice Act III, scene I: “If you prick us, do we not bleed? if you tickle us, do we not laugh? if you poison us, do we not die? and if you wrong us, shall we not revenge?"