Comparison of the analgesic effects of multimodal approach and fentanyl alone during shock wave lithotripsy
Keywords:
ESWL, analgesic, etoricoxib, fentanylAbstract
Background : So far, there has been no consensus on pain control during extracorporeal shock wave lithotripsy (ESWL).
Objective : To compare the analgesic effects of etoricoxib plus fentanyl with placebo plus fentanyl during ESWL in a prospective, randomized clinical trial.
Methods : Ninety-four patients were randomized into two groups: group A (n = 48) received etoricoxib 90 mg orally 1 hour and fentanyl 50 μg intravenously 15 minutes before procedure; group B (n = 46), placebo drug were given orally 1 hour and fentanyl 50 μg intravenously 15 minutes before procedure. Pain assessment was done with the 10-score linear visual analogue pain scale (VAS) before procedure (0 minute) and then every 15 minutes (15, 30 and 45 minutes) until the procedure was finished. The adverse effects were recorded immediately postoperative periods and at 24-hr postoperative periods.
Results : Mean difference of VAS between group A and B at 0, 15, 30 and 45 minutes were -0.14 (P = 0.530), 0.36 (P = 0.453), -0.15 (P = 0.793) and -0.12 (P = 0.822), respectively. The differences were not statistically significant. In group A, one patient (2%) had urticaria and another (2%) had petechiae at immediate post-operative, and another (2%) at 24-hr postoperative periods.
Conclusion : Our study shows that the analgesic efficacy of multimodal approach by etoricoxib and fentanyl is insignificantly different from that of placebo and fentanyl.
Downloads
References
Aybek Z, Turan T, Yonguc T, Bozbay C, Atahan O, Tuncay OL. Requirement of analgesia for extracorporeal shock wave lithotripsy and efficacy of a nonsteroidal anti-inflammatory drug: piroxicam. Eur Urol 1998;34:207-9. https://doi.org/10.1159/000019714
Knudsen F, Jorgensen S, Bonde J, Andersen JT, Mogensen P. Anesthesia and complications of extracorporeal shock wave lithotripsy of urinary calculi. J Urol 1992;148:1030-3.
https://doi.org/10.1016/S0022-5347(17)36807-6
Tauzin-Fin P, Delort-Laval S, Krol-Houdek MC, Maurette P, Bannwarth B. Effect of balanced analgesia with buprenorphine on pain response and general anaesthesia requirement during lithotripsy procedures. Eur J Anaesthesiol 1998;15:147-52. https://doi.org/10.1111/j.0265-0215.1998.00250.x
Cepeda MS, Diaz JE, Hernandez V, Daza E, Carr DB. Music does not reduce alfentanil requirement during patient-controlled analgesia (PCA) use in extracorporeal shock wave lithotripsy for renal stones. J Pain Symptom Manage 1998;16:382-7. https://doi.org/10.1016/S0885-3924(98)00099-2
Gesztesi Z, Rego MM, White PF. The comparative effectiveness of fentanyl and its newer analogs during extracorporeal shock wave lithotripsy under monitored anesthesia care. Anesth Analg 2000;90:567-70. https://doi.org/10.1097/00000539-200003000-00013
Joo HS, Perks WJ, Kataoka MT, Errett L, Pace K, Honey RJ. A comparison of patient-controlled sedation using either remifentanil or remifentanil-propofol for shock wave lithotripsy. Anesth Analg 2001;93(5):1227-32. https://doi.org/10.1097/00000539-200111000-00037
Kararmaz A, Kaya S, Karaman H, Turhanoglu S. Effect of the frequency of transcutaneous electrical nerve stimulation on analgesia during extracorporeal shock wave lithotripsy. Urol Res 2004;32:411-5.
https://doi.org/10.1007/s00240-004-0438-2
Resim S, Gumusalan Y, Ekerbicer HC, Sahin MA, Sahinkanat T. Effectiveness of electroacupuncture compared to sedo-analgesics in relieving pain during shockwave lithotripsy. Urol Res 2005;33:285-90.
https://doi.org/10.1007/s00240-005-0473-7
Sa Rego MM, Inagaki Y, White PF. Remifentanil administration during monitored anesthesia care: are intermittent boluses an effective alternative to a continuous infusion? Anesth Analg 1999;88:518-22.
https://doi.org/10.1213/00000539-199903000-00009
Yang CP, Cherng CH, Wong CS, Ho ST. Effects of intravenous ketorolac and fentanyl combined with midazolam on analgesia and side effects during extracorporeal shock wave lithotripsy. Acta Anaesthesiol Sin 2002; 40:9-12.
Power I, Chambers WA, Greer IA, Ramage D, Simon E. Platelet function after intramuscular diclofenac. Anaesthesia 1990;45:916-9. https://doi.org/10.1111/j.1365-2044.1990.tb14618.x
Schelling G, Weber W, Mendl G, Braun H, Cullmann H. Patient controlled analgesia for shock wave lithotripsy: the effect of selfadministered alfentanil on pain intensity and drug requirement. J Urol 1996;155:43-7. https://doi.org/10.1016/S0022-5347(01)66534-0
Tu J, Matula TJ, Bailey MR, Crum LA. Evaluation of a shock wave induced cavitation activity both in vitro and in vivo. Phys Med Biol 2007; 52:5933-44. https://doi.org/10.1088/0031-9155/52/19/014
Gupta NP, Kumar A. Analgesia for pain control during extracorporeal shock wave lithotripsy: Current status. Indian J Urol 2008;24:155-8. https://doi.org/10.4103/0970-1591.40607
Basar H, Yilmaz E, Ozcan S, Buyukkocak U, Sari F, Apan A,Batislam E. Four analgesic techniques for shockwave lithotripsy: eutectic mixture local anesthetic is a good alternative. J Eendourol 2003;17:3-6.
https://doi.org/10.1089/089277903321196706
Allman DB, Richlin DM, Ruttenberg M, Sotolongo JR, Jr. Analgesia in anesthesia-free extracorporeal shock wave lithotripsy: a standardized protocol. J Urology 1991;146:718-20.
https://doi.org/10.1016/S0022-5347(17)37903-X
Berwin JT, El-Husseiny T, Papatsoris AG, Hajdinjak T, Masood J, Buchholz N. Pain in extracorporeal shock wave lithotripsy. Urol Res 2009;37:51-3. https://doi.org/10.1007/s00240-009-0171-y
Chia YY, Liu K. Prospective and randomized trial of intravenous tenoxicam versus fentanyl and tramadol for analgesia in outpatient extracorporeal lithotripsy. Acta Anaesthesiol Sin 1998; 36: 17-22.
Zhang S, Zhang Y, Liu P, Zhang W, Ma JL, Wang J. Efficacy and safety of etoricoxib compared with NSAIDs in acute gout: a systematic review and a meta-analysis. Clin Rheumatol 2016;35: 151-8.
https://doi.org/10.1007/s10067-015-2991-1
Turajane T, Wongbunnak R, Patcharatrakul T, Ratansumawong K, Poigampetch Y, Songpatanasilp T. Gastrointestinal and cardiovascular risk of non-selective NSAIDs and COX-2 inhibitors in elderly patients with knee osteoarthritis. J Med Assoc Thai 2009; 92:S19-26.
Mitsogiannis IC, Anagnostou T, Tzortzis V, Karatzas A, Gravas S, Poulakis V, et al. Analgesia during extracorporeal shockwave lithotripsy: fentanyl citrate versus parecoxib sodium. J Endourol 2008;22:623-6. https://doi.org/10.1089/end.2007.0344
Greene TD, Joseph JV, Erturk E. Evaluation and management of post-shock wave lithotripsy pain with third-generation lithotriptors using rofecoxib. J Endourol 2009;23:395-8.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Chulalongkorn Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
