Liu J et al, 2013: Comparative Study between Three Analgesic Agents for the Pain Management during Extracorporeal Shock Wave Lithotripsy
Liu J, Zang YJ
Yun-Jiang Zang, Department of Urologic Surgery, Weifang People's Hospital, 151 Guangwen Street, Kuiwen District, Weifang, Shandong, China
PURPOSE: To compare the clinical efficacy between locally applied diclofenac diethylamine gel, EMLA cream and systemically given diclofenac sodium for the pain relief during extracorporeal shock wave lithotripsy (SWL) using Dornier Delta Compact Lithotripter.
MATERIAL AND METHODS: One hundred five patients with renal stones were randomly divided in to3 groups. Group A was given intramuscular diclofenac sodium (1 mg/kg), 45 minutes before the procedure. In group B, 10 gm of eutectic mixture of local anesthetic (EMLA) cream and in group C, 15 gm of diclofenac diethylamine gel was applied locally 45 minutes before the procedure. Ten-score linear and visual analogue scale (VAS) was used to assess the severity of pain during the procedure. Analysis of variance (ANOVA) test was used to compare various parameters analysed statistically.
RESULTS: All the three groups were not statistically different with respect to age, weight, stone size, number of shock wave delivered and maximum voltage used (P > .05). The mean pain score in group A was 4.48, in group B was 3.60 and in group C was 3.95, which were not significantly different (P = 1.34). Complication like skin lesion was found only in injection diclofenac sodium group whereas cold sensation at the local site was typically found in diclofenac diethylamine gel group.
CONCLUSION: Although not statistically significant, the mean pain score in locally applied analgesic agents (EMLA and diclofenac diethylamine gel) is lower as compared to intramuscularly given diclofenac sodium. Among these two locally acting drugs, diclofenac diethylamine gel is an equally effective alternative to EMLA.
Urol J. 2013 Sep 26;10(3):942-5.
PMID:24078500 [PubMed - in process]
The results concerning the different methods of analgesia were to be expected according to what is known from the literature. Two details are missed in this manuscript:
1. The time when the pain assessment was done is not given. It has been shown that pain perception during SWL varies within the treatment period (Kumar et al. J Endourol. 2007, 21: 578- 582)
2. The SWLsuccess rate is not given. The number of shots and the power level in this series are very low. Other authors used much higher number of shots (Ng et al. J Endourol. 2006, 20: 1-8) and higher voltage (Kumar et al. J Endourol. 2007, 21: 578- 582) ( This review series: Tanaka M, et al. Korean J Urol. 2013 Jul;54(7):454-9) for the treatment of similar stone sizes with the same lithotripter. It cannot be excluded that the low energy level and low number of shots are the reason for a non-significant difference in pain score in the three groups.