Zareian Baghdadabad L. et al., 2025: Evaluation of the analgesic effect of a combination of oral acetaminophen and oxycodone after extracorporeal shock wave lithotripsy (SWL).
Leila Zareian Baghdadabad 1, Abdolreza Mohammadi 1, Iman Menbari Oskouie 1, Farshid Alaeddini 2, Hirad Farajidavar 1 3, Leonardo Oliveira Reis 4, Seyed Mohammad Kazem Aghamir 1
1Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
2Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
3Department of Clinical Pharmacy, Tehran, Iran.
4UroScience and Department of Surgery (Urology), School of Medical Sciences, University of Campinas, Unicamp, and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, São Paulo, Brazil.
Abstract
Objective: The present study aimed to compare the effects of suppository diclofenac (an example of NSAIDs) and oral administration of the combination of oxycodone (an example of an opioid) and acetaminophen in managing pain in patients with renal colic after SWL treatment.
Method: The current study is a double-blind clinical trial involving individuals scheduled to receive elective SWL therapy for kidney and ureteral stones. Participants were randomly assigned to one of two groups using the block randomization technique: suppository Diclofenac (100 mg) or a combination of 325 mg Acetaminophen + 5 mg oxycodone administered orally for pain relief following SWL. Pain intensity was measured immediately after the SWL procedure, and analgesics were then given to the patients. After 30 min, pain severity was reassessed. The severity of pain in patients was documented before and after drug administration at 24, 48, and 72 h after the SWL intervention.
Results: 154 renal stone patients (63 females) underwent SWL with a mean age of 41.52 ± 10.52 years. The two groups were similar in terms of age (p = 0.572), sex (p = 0.212), location of the stone (p = 0.868), size of the stone (p = 0.762), and occurrence of complication (p = 0.302). There was no significant difference in the reduction of pain severity between the two groups after 30 min (p = 0.224), 2 days (p = 0.501), and 3 days (p = 0.229) following SWL intervention. However, after a 24-h follow-up, pain severity decreased more in the diclofenac group compared to the other group (p = 0.002).
Conclusion: The combination of oxycodone and acetaminophen, including a multimodal analgesic approach, can be considered a preferred option in the clinical setting for pain management of patients undergoing SWL. It provides relief for patients as effectively as NSAIDs, with the same safety profile, leading to high patient satisfaction.
Urologia. 2025 Feb 14:3915603251317046. doi: 10.1177/03915603251317046. Online ahead of print. PMID: 39950358
Comments 1
The authors compared the pain-reduction following piezoelectric lithotripsy with either 100 mg of NSAID or Faroxyphen (which is a combination of 325 mg of Acetaminophen and 5mg of oxycodone). The surprising part of the report is the authors’ conclusion that Faroxyphen….can be considered a preferred option…for patients undergoing SWL.” and that this agent provides relief of pain as efficiently as NSAIDs.
This statement takes the history of treating patients with renal colic another round. When I started my urological career some 60 years ago the problem was that we only had access to opioids to treat patients with renal colic. The serious consequence was that many patients became drug addicted. That added another component to the problem of stone disease. Therefore, one of the greatest inventions in urology was the possibility to efficiently treat patients with renal colic by administration of NSAIDs. Thereby the use of opioids for renal colic was stopped and used only exceptionally. Accordingly, opioid addiction almost completely disappeared!.
The reader can draw his/her own conclusions, but in my opinion avoiding opioids is a great advantage.
Hans-Göran Tiselius