Dawson C, Vale J A, Corry D A, Cohen N P, Gallagher J, Nockler I B, Whitfield H N
Department of Urology, St Bartholomew's Hospital, London, UK.
Br J Urol. 1994 Sep;74(3):302-7. doi: 10.1111/j.1464-410x.1994.tb16615.x.
To determine the best choice of analgesic for patients undergoing lithotripsy, and to attempt to identify factors which might predict which patients are most likely to find the procedure painful.
Sixty patients with stones in the pelvicalyceal system of the kidney were randomized prospectively to undergo lithotripsy with the Dornier MPL9000 lithotripter (Dormier Medical Systems, Marietta, GA, USA) after receiving either diclofenac 100 mg per rectum (n = 30) or pethidine 50 mg intravenously (n = 30) for analgesia. The patients completed a detailed questionnaire prior to treatment, and the level of pain perceived during lithotripsy was monitored using visual analogue scales (VASs). Arterial oxygen saturation (SaO2) was monitored before analgesia was given, throughout the treatment and for 30 min after cessation of treatment.
The VASs were available for 56 patients and the results of pulse oximetry for 51 patients. Although a higher kilovoltage was recorded in the group who received pethidine this difference was not significant. Patients who received diclofenac or pethidine alone, showed a non-significant fall of SaO2 30 minutes after the end of treatment, although the largest fall in SaO2 observed with pethidine was 10%. Patients who received diclofenac and pethidine similarly showed a non-significant fall in SaO2. Four patients received intravenous benzodiazepines in addition to pethidine, and in this group there was a dramatic fall in SaO2 which persisted more than 30 min after the end of treatment (P < 0.0027). Diclofenac provided effective analgesia for most of the patients who underwent lithotripsy. Overall 11 patients (18%) required additional analgesia. Diclofenac or pethidine alone, in the doses used in this study, did not cause a significant drop in SaO2 during ESWL. The only response found to be of value in predicting a painful experience was fear of the dentist.
This study shows that modern lithotripsy, in addition to being safe and effective, can be performed as an out-patient procedure using simple non-opiate analgesics. The need for stronger analgesia and/or sedation should be tailored to the needs of the individual patient, although it remains difficult to predict which patients will require such measures.
确定接受碎石术患者的最佳镇痛选择，并试图找出可能预测哪些患者最有可能觉得该手术疼痛的因素。
60例肾盂肾盏系统有结石的患者被前瞻性随机分组，在接受直肠给予双氯芬酸100mg（n = 30）或静脉注射哌替啶50mg（n = 30）镇痛后，使用多尼尔MPL9000碎石机（美国佐治亚州玛丽埃塔市多尼尔医疗系统公司）进行碎石术。患者在治疗前完成一份详细问卷，并使用视觉模拟评分法（VAS）监测碎石术中的疼痛程度。在给予镇痛前、整个治疗过程及治疗结束后30分钟监测动脉血氧饱和度（SaO2）。
56例患者有VAS评分结果，51例患者有脉搏血氧饱和度测定结果。虽然接受哌替啶的组记录到较高的千伏值，但差异无统计学意义。单独接受双氯芬酸或哌替啶的患者在治疗结束后30分钟时SaO2有非显著性下降，尽管观察到哌替啶导致的最大SaO2下降为10%。接受双氯芬酸和哌替啶的患者同样显示SaO2有非显著性下降。4例患者除接受哌替啶外还接受了静脉注射苯二氮䓬类药物，该组患者SaO2急剧下降，在治疗结束后持续超过30分钟（P < 0.0027）。双氯芬酸为大多数接受碎石术的患者提供了有效的镇痛。总体而言，11例患者（18%）需要额外镇痛。在本研究使用的剂量下，单独使用双氯芬酸或哌替啶在体外冲击波碎石术期间未导致SaO2显著下降。发现唯一对预测疼痛体验有价值的反应是对看牙医的恐惧。
本研究表明，现代碎石术除了安全有效外，使用简单的非阿片类镇痛药可作为门诊手术进行。虽然仍难以预测哪些患者需要更强的镇痛和/或镇静措施，但应根据个体患者的需求来调整。
