Fouladi A et al, 2017: Comparison of Different Analgesic Techniques for Pain Relief During Extracorporeal Shock Wave Lithotripsy: a Double-blind, Randomized Clinical Trial.
Fouladi A, Soleimani A.
Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
BACKGROUND: Most patients experience some degree of pain during extracorporeal shock waves lithotripsy (ESWL).
AIM: The aim of this study was to evaluate the effect of target-controlled infusion (TCI) of remifentanil or sufentanil and patient-controlled analgesia (PCA) with sufentanil or morphine for pain relief during ESWL.
MATERIALS AND METHODS: In a double blind, randomized clinical trial, a total of 60patients who were scheduled for elective ESWL, randomly assigned into four groups (A, B, C and D). Patients in group A and B received remifentanil and sufentanil with TCI, respectively. Also, patients in group C and D received sufentanil and morphine with PCA, respectively. All patients in four groups were assessed about the intensity of their pain with Visual Analogue Scale (VAS) in three phases; the discharge of the waves (phase A), during breaking the stones (phase B) and the end of the procedure (phase C). RESULTS: Patients in morphine PCA group experienced highest pain intensity in all stages, but patients in remifentanil TCI group experienced lowest pain intensity during lithotripsy. Remifentanil/TCI group experienced the lowest pain in B and C phases and the sufentanil/TCI group had the lowest pain only in the phase A. There was no significant difference in the occurrence of complications in all four groups.
CONCLUSION: The current study demonstrates that efficacy of TCI pump in the reduction of pain during ESWL is superior to the PCA pump. Among the drugs that used in this study, remifentanil has more effective in pain management in the all phases during ESWL. We believe that using remifentanil/TCI should strongly be considered to clinicians in ESWL units.
Acta Inform Med. 2017 Jun;25(2):94-98. doi: 10.5455/aim.2017.25.94-98. FREE ARTICLE
The different outcomes in the two-armed study are partially explained by the use of different drug combinations and partially by the fact that in a patient-controlled PCA- regimen there is a continuous low dose infusion but the patient has to feel pain as an indicator to start the individual add-on bolus pump. Contrary to PCA “ TCI delivers a drug according to a pharmacokinetic model which takes into account the patient’s age and weight, balancing rates of infusion, distribution, and elimination to achieve a ‘‘target’’ blood concentration of the drug”.
The authors mention costs by the statement that compared to fixed doses pain therapy, “the only disadvantage of the PCA pump is the high cost of this method. Although using this method reduces the dosage of drugs needed for pain control, resulting in a reduction of side effects of this treatment, finally reduce the overall costs.”
The argument also seems to apply also for TCI, as “the costs of the TCI are not higher.”
A good paper to discuss with the anaesthetist.