Karaaslan M. et al., 2023: Erector spinae plane block prior to extracorporeal shock wave lithotripsy decreases fluoroscopy time and promise a comfortable procedure for renal stones: A prospective randomized study.
Servicio de Urología, Hospital Estatal de Bingol, Bingol, Turkey.
Servicio de Urología, Universidad de Ciencias de la Salud, Hospital de la Ciudad de Ankara, Ankara, Turkey.
Servicio de Anestesiología y Reanimación, Universidad de Ciencias de la Salud, Hospital Municipal de Ankara, Ankara, Turkey.
Facultad de Medicina, Universidad de Estambul, Servicio de Urología, Estambul, Turkey.
Servicio de Urología, Centro Médico Universitario de Friburgo, Facultad de Medicina, Friburgo, Germany.
Introduction and objectives: To compare the efficacy of erector spinae plane block (ESPB) and intramuscular (i.m.) diclofenac sodium in regard to pain management and impact on stone-free status in patients undergoing SWL.
Patients and materials: The study included patients who underwent SWL for kidney stones in our institution. The patients were randomly assigned to the ESPB (Group 1: n = 31) and i.m. 75 mg diclofenac sodium (Group 2: n = 30) groups. The demographic data of the patients, fluoroscopy time during SWL, number of need of targeting, total shocks given, voltage, stone free rates (SFR), analgesy method, number of SWL sessions, VAS score, stone location, maximum stone size, stone volume and Hounsfield unit (HU) were also recorded.
Results: A total of 61 patients were included the study. There was no statistically significant difference between the two groups according to stone size, volume and density, SWL duration, total shocks given, voltage, BMI, stone-free status and stone location. Fluoroscopy time and number of need for stone targeting were significantly lower in group 1 than group 2 (p = 0.002, p = 0.021, respectively). The VAS score was significantly lower for group 1 compared to group 2 (p < 0.001).
Conclusions: We observed that the VAS score was lower in the ESPB group compared to i.m. diclofenac sodium group and although it was not statistically significant, we achieved a higher rate of stone-free status in the first session in ESPB group. Most importantly, the patients in the ESPB group were exposed to less fluoroscopy and radiation.
Actas Urol Esp (Engl Ed). 2023 Apr 20:S2173-5786(23)00041-0. doi: 10.1016/j.acuroe.2023.04.001. Online ahead of print.PMID: 37084807 English, Spanish
One of the most important observations during SWL is that successful stone disintegration requires effective pain treatment. When first introduced in the 1980ies it was assumed that SWL was impossible without regional or general anesthesia. Subsequent clinical goals, however, were to give SWL with as little analgesics as possible, when the treatment was carried out with very mild pain or entirely pain-free. To achieve that goal not only were lithotripters technically modified, but it also needs to be noted that the range of indications was narrowed. The latter point is seldom mentioned, but it stands to reason that what was achieved with the original Dornier HM3 device, even with use of only analgesics and sedatives, have been difficult to attain with modern lithotripters.
Based on almost four decades of experience with SWL it is not surprising that ESPB resulted in lower VAS-score and numerically fewer SWL sessions than was the case in patients only given diclofenac. Another important point was that the need of re-adjustment of patients’ positions were less common in the ESPB group.
Although ESPB obviously resulted in satisfactory pain treatment with the electrohydraulic lithotripter used in this randomized study, the method requires an anesthetist with sufficient experience in this kind of blockage. Compared with intermittent administration of small doses of alfentanil and propofol, nerve blockade is more time consuming and more expensive.
Whichever method that is used for pain treatment, most important, however, is that it is efficient enough so that the SWL procedure can be continued without patient reactions and without patient movement.