Kiaei Mehrdad Mesbah, Mohaghegh Mahmoud Reza, Movaseghi Gholamreza, Ghorbanlo Masoud
Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Department of Anesthesia and Critical Care, Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Eur J Transl Myol. 2018 May 2;28(2):7353. doi: 10.4081/ejtm.2018.7353. eCollection 2018 Apr 24.
Urinary system stones are the third most common disease of urinary system following urinary infection and prostate pathology. Extracorporeal shockwave lithotripsy (ESWL) is one of the methods used to treat Urolithiasis where shockwaves are transmitted through skin and body organs and crush the stones into small pieces. This is a painful procedure which usually requires analgesics. Each analgesic drug has its own advantages and disadvantages. The present research seeks to study the effectiveness of using diclofenac suppository in order to control pain and reduce need for venous drugs during ESWL procedure. This is a double blind clinical trial. 158 patients resorting to Shahid Hasheminezhad Specialized Center for ESWL were randomly selected to take part in this projects with due consideration of inclusion criteria. The patients were equally divided into the S (diclofenac suppository) and A (placebo) groups. 2 diclofenac suppositories were used in the S group 20 minutes prior to beginning ESWL. Then, ESWL was carried out in supine position using fluoroscopic conduction with standard method. The present research has studied pain scale of patients, operator's and patient's satisfaction during the operation and patient's hemodynamic parameters in three phases prior to, during, and after ESWL. SPSS v.17 was used to study the data and Chi-Square Tests and Repeated Measure ANOVA were used to analyze the results. The level of significance in the present research was set to P-value < 0.05.A review of pain scales across both groups showed that using diclofenac suppository has a significant influence in reducing the pain scale and, hence, need for venous drugs (P-value < 0.05). No significant difference was observed between the two groups in terms of heart beat and blood pressure changes in various times (P-value > 0.05). The results also report different satisfaction levels for patients and operators across the two groups (diclofenac suppository and placebo) (P-value < 0.05). Higher satisfaction levels were observed among both patients and operators in the group receiving diclofenac suppository. A general look at the data yields the conclusion that receiving pain killers (diclofenac suppository) before starting ESWL plays a more efficient role in reducing pain scales of patients and enhancing operators' satisfaction..
泌尿系统结石是继泌尿系统感染和前列腺疾病之后泌尿系统第三常见的疾病。体外冲击波碎石术（ESWL）是用于治疗尿路结石的方法之一，冲击波通过皮肤和身体器官传播，将结石粉碎成小块。这是一个痛苦的过程，通常需要使用镇痛药。每种镇痛药都有其优缺点。本研究旨在探讨使用双氯芬酸栓剂在ESWL手术过程中控制疼痛和减少静脉用药需求的有效性。这是一项双盲临床试验。在充分考虑纳入标准的情况下，随机选择158名到哈希米内贾德烈士专科医院进行ESWL治疗的患者参与本项目。患者被平均分为S组（双氯芬酸栓剂组）和A组（安慰剂组）。S组在开始ESWL前20分钟使用2枚双氯芬酸栓剂。然后，采用标准方法在仰卧位使用荧光透视引导进行ESWL。本研究在ESWL术前、术中和术后三个阶段研究了患者的疼痛评分、术者和患者的满意度以及患者的血流动力学参数。使用SPSS v.17对数据进行研究，并使用卡方检验和重复测量方差分析对结果进行分析。本研究的显著性水平设定为P值<0.05。对两组疼痛评分的回顾表明，使用双氯芬酸栓剂对降低疼痛评分以及因此减少静脉用药需求有显著影响（P值<0.05）。两组在不同时间的心跳和血压变化方面未观察到显著差异（P值>0.05）。结果还报告了两组（双氯芬酸栓剂组和安慰剂组）患者和术者的不同满意度水平（P值<0.05）。在接受双氯芬酸栓剂的组中，患者和术者的满意度更高。综合来看这些数据得出的结论是，在开始ESWL前接受止痛药（双氯芬酸栓剂）在降低患者疼痛评分和提高术者满意度方面发挥了更有效的作用。
