Category: Clinical Stones: SWL

MP9-14 - Efficacy of Pethidine, Ketorolac And Lidocaine Gel As Analgesics For Pain Control In Shockwave Lithotripsy. A Single Blinded Randomized Controlled Trial

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective :

Although European guidelines stated that pain control during Shockwave Lithotripsy (SWL) is necessary, no recommendation for proper analgesia in contrast to clear one for pain relief in acute stone episode. Consequently, across 21 centers in UK, 17 distinct analgesia regimens were reported for SWL. We aim to compare the analgesic safety and efficacy of different analgesia for SWL.


Methods :

A single-blinded randomized controlled study registered in clinicaltrials.gov (NCT03032458) for patients with renal and upper ureteral stones amenable to SWL between January and October 2017. Patients were randomized to 3 groups: the 1st received pethidine 25 mg IV bolus injection before session plus placebo gel and pethidine 25 IV infusion during session, the 2nd received ketorolac 30 mg IV bolus injection before session plus placebo gel then 30 mg IV infusion; the 3rd received lidocaine 2% gel locally before session plus 10 mg normal saline IV bolus then IV normal saline infusion. A visual analog scale (VAS) was used for pain evaluation. A kidney, ureter, and bladder (KUB) x-ray and Ultrasound scan (US) one week after SWL single session used for stone disintegration assessment, if no residual NCCT was done. Disintegration were classified to no (no change from basal by KUB or US), partial (fragmented and >4mm residual) and complete (≤4mm residual).


Results :

Patients’ data and stone characteristics as shown in table (1). SWL sessions parameters with pain rating shown in table (2). For lidocaine group, six session (20.7%) were aborted and supplement analgesic were added and only 5 patient (17%) were satisfied; so stop randomization to this arm. Regarding to stone disintegration as no, partial and complete results were: 25 (50%), 23 (46%), 2(4%) for pethidine; 19 (35.8%), 23 (43.3%), 11 (20.7%) for ketorolac and 26 (89.6%), 3 (10.3%), 0 (0%) for lidocaine, respectively (P=0.008).


Conclusions :

Ketorolac is more safe and effective alternative to morphine derivatives as sedoanalgesia for SWL. Lidocaine gel could be used as adjuvant not as mono-sedoanalgesia for SWL.

Ahmed HASSAN. Elkashef

Urology Resident
Urology and Nephrology Center, Mansoura University, Egypt.
Mansoura, Ad Daqahliyah, Egypt

Ahmed Hassan Elkashef,
Resident in urology,
Urology & Nephrology Center, Mansoura University, Egypt.

Abdelwahab Hashem

Clinical fellow
Urology and Nephrology Center, Mansoura University, Egypt.
Mansoura, Ad Daqahliyah, Egypt

Fady K. Ghobrial

Clinical fellow
Urology and Nephrology Center, Mansoura University, Egypt.
Mansoura, Ad Daqahliyah, Egypt

Mohamed Abdelbast

Clinical fellow
Urology and Nephrology Center, Mansoura University, Egypt.
Mansoura, Ad Daqahliyah, Egypt

Ahmed Atwa

Pediatric department
Urology and Nephrology Center, Mansoura University, Egypt.
Mansoura, Ad Daqahliyah, Egypt

Mohamed Fadallah

Urology Resident
Urology and Nephrology Center, Mansoura University, Egypt.
Mansoura, Ad Daqahliyah, Egypt

Mahmoud Laymon

Endourology and laparoscopy unit
Urology and Nephrology Center, Mansoura University, Egypt.
Mansoura, Ad Daqahliyah, Egypt

Magdy Elshabrawy

Urology and Nephrology Center, Mansoura University, Egypt.
Mansoura, Ad Daqahliyah, Egypt

Mohamed Badawy

Fellow
Radiology department. Urology and Nephrology Center, Mansoura University, Egypt.
Aljizah, Al Jizah, Egypt

Ahmed El-Assmy

Urology Professor
Urology and Nephrology Center, Mansoura University, Egypt.
Mansoura, Ad Daqahliyah, Egypt

Khalid Sheir

Head of Shock Wave Unit
Urology and Nephrology Center, Mansoura University, Egypt.
Mansoura, Ad Daqahliyah, Egypt

Hassan Abol-Enein

Urology Professor
Urology and Nephrology Center, Mansoura University, Egypt.
Mansoura, Ad Daqahliyah, Egypt