Mitsogiannis Iraklis C, Anagnostou Theodore, Tzortzis Vassilios, Karatzas Anastasios, Gravas Stavros, Poulakis Vassilis, Melekos Michael D
Department of Urology, University of Thessaly School of Medicine, Larissa, Greece.
J Endourol. 2008 Apr;22(4):623-6. doi: 10.1089/end.2007.0344.
Shockwave-induced pain may become an important issue during extracorporeal shockwave lithotripsy (SWL), although the new generation of lithotriptors generally produces less pain than previous models. The aim of the study was to compare the analgesic effect of a cyclooxygenase-2-specific inhibitor (parecoxib sodium) with that of our standard method of analgesia (fentanyl citrate) in patients who needed pain relief when undergoing SWL.
Fifty-eight patients who were undergoing SWL for renal calculi were randomized to receive intravenously either fentanyl citrate (group A, n = 30) or parecoxib sodium (group B, n = 28) when they felt that their pain during the session became intolerable. Lithotripsy was recommenced 10 minutes after administration of analgesia. The severity of pain before and after administration of the analgesic regimens was evaluated using a five-level verbal scale. The effectiveness of each drug was evaluated with respect to degree of pain relief and ensuing tolerance of the procedure to completion, as well as the need for supplementary analgesia (half the standard dose of fentanyl citrate).
The patients in the two groups were comparable with regard to age, sex, body mass index, and stone size. There was no statistically significant difference in the maximum energy level achieved as well as in the total number of shock waves given in the two groups. Administration of fentanyl citrate resulted in alleviation of pain and completion of SWL in 27 patients (90%), whereas parecoxib sodium was effective in five patients (17.8%) (P < 0.01). The remaining 23 patients in group B received supplementary analgesia, and 22 completed the lithotripsy session.
Parecoxib sodium was not as effective as fentanyl citrate in alleviating pain during SWL. Its use, however, may lower the dose of opioid-based analgesia in this group of patients.
尽管新一代碎石机产生的疼痛通常比以前的型号少，但冲击波诱导的疼痛可能会成为体外冲击波碎石术（SWL）期间的一个重要问题。本研究的目的是比较环氧化酶-2特异性抑制剂（帕瑞昔布钠）与我们的标准镇痛方法（枸橼酸芬太尼）对接受SWL时需要缓解疼痛的患者的镇痛效果。
58例接受肾结石SWL治疗的患者，当他们感到术中疼痛难以忍受时，随机分为静脉注射枸橼酸芬太尼（A组，n = 30）或帕瑞昔布钠（B组，n = 28）。镇痛药物给药10分钟后重新开始碎石。使用五级语言量表评估镇痛方案给药前后的疼痛严重程度。根据疼痛缓解程度、随后对手术完成的耐受性以及补充镇痛（枸橼酸芬太尼标准剂量的一半）的需求来评估每种药物的有效性。
两组患者在年龄、性别、体重指数和结石大小方面具有可比性。两组在达到的最大能量水平以及给予的冲击波总数方面没有统计学上的显著差异。枸橼酸芬太尼给药后，27例患者（90%）疼痛缓解并完成了SWL，而帕瑞昔布钠仅对5例患者有效（17.8%）（P < 0.01）。B组其余23例患者接受了补充镇痛，22例完成了碎石疗程。
在SWL期间，帕瑞昔布钠在缓解疼痛方面不如枸橼酸芬太尼有效。然而，在这类患者中使用它可能会降低基于阿片类药物的镇痛剂量。
