Choudhary Arpan, Basu Supriya, Sharma Rakesh, Gupta Rupesh, Das Ranjit Kumar, Dey Ranjan Kumar
Department of Urology, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India.
Department of Urology, Apex Hospital, Jaipur, Rajasthan, India.
Urol Ann. 2019 Jan-Mar;11(1):66-71. doi: 10.4103/UA.UA_15_18.
Analgesia during extracorporeal shockwave lithotripsy for renal stone is an essential component. It not only makes the procedure comfortable but also increases the stone-free rate.
The aim of this study was to evaluate the efficacy of triple oral analgesic agents on stone fragmentation and pain relief in comparison to injectable analgesic agents.
This prospective randomized study included 68 patients of renal calculi of size 5-15 mm.
Group A had 32 patients, who received injection pentazocine and injection diclofenac, 45 min before the procedure. Group B consisted of 28 patients, who received a combination of oral acetaminophen, 325 mg, oral diclofenac 50 mg, and oral tramadol 37.5 mg, 45 min prior. Procedural findings, pain score visual analog scale (VAS), fragmentation rate, and outcome were recorded.
Independent -test and Pearson's correlation test.
A total of 60 patients were analyzed. The mean age was 40.2 ± 11.8 years. Both groups were comparable in body mass index, stone size, number, and density. Group A required more shocks than Group B (4274 vs. 3693, = 0.043). A lower energy level of shocks (kV) was tolerated in Group A (2.5 vs. 3.2, = 0.002). Group A required more sittings than Group B (2.3 vs. 1.9, = 0.037). VAS score was significantly less in Group B (2.9 vs. 4.9, = 0.0001). The overall fragmentation rate was similar among groups (81.2% vs. 89.3%); hence, the successful outcome was (59.4% vs. 75.0%, = 0.274). The occurrence of adverse events was also equivalent in both groups ( = 0.199).
Triple oral regime provides better analgesic effect and quicker stone-free rate than injectable agents but with similar final outcome.
体外冲击波碎石术治疗肾结石时的镇痛是一个重要组成部分。它不仅能使手术过程更舒适，还能提高结石清除率。
本研究的目的是评估三联口服镇痛药与注射用镇痛药相比对结石破碎和疼痛缓解的疗效。
这项前瞻性随机研究纳入了68例结石大小为5 - 15毫米的肾结石患者。
A组有32例患者，在手术前45分钟接受喷他佐辛注射液和双氯芬酸注射液。B组由28例患者组成，在术前45分钟接受325毫克对乙酰氨基酚、50毫克双氯芬酸和37.5毫克曲马多的联合口服。记录手术结果、疼痛评分视觉模拟量表（VAS）、破碎率和结局。
独立t检验和Pearson相关检验。
共分析了60例患者。平均年龄为40.2±11.8岁。两组在体重指数、结石大小、数量和密度方面具有可比性。A组比B组需要更多的冲击波次数（4274次对3693次，P = 0.043）。A组能耐受的较低能量水平的冲击波（千伏）（2.5对3.2，P = 0.002）。A组比B组需要更多的治疗次数（2.3次对1.9次，P = 0.037）。B组的VAS评分显著更低（2.9对4.9，P = 0.0001）。两组的总体破碎率相似（81.2%对89.3%）；因此，成功结局相似（59.4%对75.0%，P = 0.274）。两组不良事件的发生率也相当（P = 0.199）。
三联口服方案比注射用药物具有更好的镇痛效果和更快的结石清除率，但最终结局相似。
