Department of Anesthesia, School of Medicine, Duzce University, Duzce, Turkey.
J Endourol. 2010 Apr;24(4):615-20. doi: 10.1089/end.2009.0483.
Extracorporeal shockwave lithotripsy (SWL) is the mainstay treatment modality for upper urinary tract stones. However, it is a relatively painful procedure and so an efficient analgesia is required for better clinical success. The ideal method of anesthesia has not been standardized. The objective of this randomized study, for the first time in the literature, was to compare the efficacy of three common analgesics, each belonging to a different group, in pain control during SWL.
In this randomized controlled study, 90 patients with upper urinary tract stones undergoing SWL were randomly divided into three groups. Group I (n = 30) received 1 g of paracetamol, group II (n = 30) received 8 mg of lornoxicam, and group III (n = 30) had 1 mg/kg of tramadol. No premedication was applied in all groups. Pain scores by visual analog scale (VAS), blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation were noted before procedure and at 1 minute and every 5 minutes during the SWL. Supplementary analgesic consumption was recorded. Moreover, all adverse effects and both patient and urologist satisfaction were documented.
Demographic parameters of the three groups were similar. All monitored parameters were also not different among the groups. The mean VAS scores at all measured times during SWL were below 4 except for two occasions, indicating a relatively efficient overall pain control provided by these three medications. Moreover, the mean VAS scores were similar among these three groups at all measured times during SWL except for those at 5 and 20 minutes at which groups III and II showed lesser pain control, respectively. No difference was observed in the amount of supplementary analgesia, which was required at higher voltages in a majority of patients. There was no significant difference in side effects.
This study suggests that paracetamol, lornoxicam, and tramadol can be safely and efficiently preferred in pain control during SWL.
体外冲击波碎石术（SWL）是治疗上尿路结石的主要方法。然而，它是一种相对疼痛的程序，因此需要有效的镇痛以获得更好的临床效果。理想的麻醉方法尚未标准化。本随机研究的目的是首次比较三种常用镇痛药在 SWL 期间控制疼痛的效果，这三种镇痛药分别属于不同的类别。
在这项随机对照研究中，90 例接受 SWL 的上尿路结石患者被随机分为三组。组 I（n = 30）接受 1 克扑热息痛，组 II（n = 30）接受 8 毫克氯诺昔康，组 III（n = 30）接受 1 毫克/千克曲马多。所有组均未进行预用药。记录视觉模拟评分（VAS）、血压、心率、呼吸频率和外周血氧饱和度的疼痛评分，分别在术前和 SWL 期间的第 1 分钟和每 5 分钟记录一次。记录补充镇痛药物的使用情况。此外，还记录了所有不良反应以及患者和泌尿科医生的满意度。
三组的人口统计学参数相似。所有监测参数在组间也无差异。除两次外，SWL 期间所有测量时间的平均 VAS 评分均低于 4，表明这三种药物的整体疼痛控制效果相对较好。此外，SWL 期间所有测量时间的平均 VAS 评分在三组之间相似，除了在第 5 分钟和第 20 分钟时，组 III 和 II 显示出较低的疼痛控制，分别。在需要大多数患者更高电压的情况下，补充镇痛药物的剂量没有差异。不良反应也没有显著差异。
本研究表明，扑热息痛、氯诺昔康和曲马多可安全有效地用于 SWL 期间的疼痛控制。
