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Browne C. et al., 2020: Strategies to maximise patient comfort during extracorporeal shockwave lithotripsy - A randomised controlled trial

Browne C, Redmond E, Kelly T, Rogers E, O'Malley P, Nusrat N, Jaffry S, Durkan G, Walsh K, Dowling C, D'Arcy FT.
Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland.
Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland.

Abstract

Background/purpose of study: We aim to assess if distraction techniques improve patient comfort tolerability of SWL.

Methods: We carried out a prospective randomised controlled trial of SWL-naïve patients attending for treatment. Patients were randomised into three groups and offered oral analgesia as standard of care. Group 1 (n = 19) received stress balls to squeeze during treatment. Group 2 (n = 19) listened to music during treatment. Group 3 (n = 17) received standard of care only. All patients completed a validated health anxiety inventory score prior to treatment. All patients completed a validated pain questionnaire and visual analogue scale (VAS) after treatment. Primary outcomes were completion of SWL treatment and pain score results.

Results: 55 patients attending for SWL were randomised. There was no difference in stone size or position, presence of a stent, height or weight between the groups. VAS scores were lower in controls compared to Group 1 (1.93 vs 3.69, p = 0.08). On subgroup analysis of non-anxious patients, pain questionnaire scores were lower in controls compared to Group 1 (2.58 vs 4.77, p = 0.06). VAS scores were lower in patients who received optional analgesia alone than in patients who received stress balls alone (1.92 vs 4.07, p = 0.05). Across all subgroups, pain scores were lower in the control group compared to the distraction groups, but did not achieve significance.

Conclusions: In conclusion, distraction techniques should not replace standard of care for analgesia during SWL. This study was registered with clinicaltrials.gov (identifier NCT03379922).
Surgeon. 2020 Aug 5;S1479-666X(20)30101-3. doi: 10.1016/j.surge.2020.07.002. Online ahead of print. PMID: 32771299

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Commentaires 1

Hans-Göran Tiselius le mercredi 23 décembre 2020 08:30

The question analyzed in this study was whether distraction methods during SWL increased patients’ comfort. In addition to administration of basic analgesics such as Tramadol, patients were given stress balls (Group 1), music in head phones (Group 2) or only standard treatment (Group 3).

It is of note that the best outcome was observed in Group 3. This result is different from that reported by Saraogi et al [1].

The number of patients in each group is small and the statistics relatively weak. When stress balls and music replaced additional analgesics patients’ comfort in terms of pain experience and anxiety was less than when additional doses of analgesics were given (Group 3).

Reference.
Saraogi M et al. Role of complementary medicine (music, acupuncture, acupressure, TENS and audio-visual distraction) in shockwave lithotripsy (SWL): A systematic review from EAU sections of urolithiasis (EULIS) and uro-technology (SEUT). Urology 2020, in press.

Hans-Göran Tiselius

The question analyzed in this study was whether distraction methods during SWL increased patients’ comfort. In addition to administration of basic analgesics such as Tramadol, patients were given stress balls (Group 1), music in head phones (Group 2) or only standard treatment (Group 3). It is of note that the best outcome was observed in Group 3. This result is different from that reported by Saraogi et al [1]. The number of patients in each group is small and the statistics relatively weak. When stress balls and music replaced additional analgesics patients’ comfort in terms of pain experience and anxiety was less than when additional doses of analgesics were given (Group 3). Reference. Saraogi M et al. Role of complementary medicine (music, acupuncture, acupressure, TENS and audio-visual distraction) in shockwave lithotripsy (SWL): A systematic review from EAU sections of urolithiasis (EULIS) and uro-technology (SEUT). Urology 2020, in press. Hans-Göran Tiselius
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