Category: Clinical Stones: SWL

MP9-12 - The effect of intracutaneous sterile water injection for pain management during extracorporal shock wave lithotripsy

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

Introduction & Objective :

Despite the latest advances, patient are still suffering during shock wave lithotirpsy and adequate analgesia is necessary in order to achieve an optimal stone fragmentation and patient satisfaction.

Intracutaneous sterile water injection (ISWI) is rapidly gaining popularity as a pain relief method for women in labour. It was also shown effectively inhibits renal colic pain with negligible side effects . The procedure is cheap and safe, requires low technology and can be performed in almost every health centers. However, studies about ISWI mostly studied on labour pain therefore studies on pain caused by urolithiasis are inadequate, especially during ESWL.

Although it is very crucial for the outcome, the most effective analgesic protocol has not been determined in SWL. We, therefore, aimed to compare the efficacy and safety of ISWI against diclofenac sodium – a NSAID -  for the management of pain during ESWL.

Methods :
A total of 526-patients with kidney stone were randomized into the sterile water injection (group I, n=223 ) and diclofenac sodium (group II, n=317) groups. Injections were applied to  the most painful or central to the most painful area in prone position using 1 ml insulin syringe with 0.5 ml of sterile water. Pain scores were assessed at every voltage increments using a visual analogue scale. Additionally, the need for rescue analgesia, stone size, total shock waves given, ESWL duration and voltage used for each patient were collected.

Results :

The characteristics of patient, stone, and ESWL are listed  in Table I.  No statistically significant differences were observed in terms of  age, sex, BMI, stone size, and number of shocks and voltage values between two groups. In addition, the mean VAS scores before and at every voltage increments were similar and no statically significant difference was found between two groups. However, the number of patients requiring rescue analgesia and adverse event rates were higher in diclofenac group (Table II). Those patients excluded from the main analysis.

Conclusions :

Considering the importance of pain treatment and side-effects of common analgesic agents during ESWL, we suggest that ISWI can be used effective, safe and cheap option in relieving pain during ESWL sessions. Further evidences are required related to ISWI techniques including optimal tissue depth and amount of sterile water for injection to obtain the greatest analgesic effects with the most patient satisfaction.

Murat Gul

Asst. Prof.
Aksaray University School Of Medicine
Aksaray, Aksaray, Turkey

Dr.Murat Gul, FEBU works as an Asst. Prof. Dr in Aksaray University School of Medicine, Department of Urology. He was born in Ankara,Turkey at 7th December 1982. After finishing Selcuk University School of Medicine in 2008 ,he worked 9 months as a general practitioner. Thereafter, he won the exam of postdoctoral training and started to work as a urology resident in Selcuk University School of Medicine in Konya. After a successfully training residency programme he had begun to work as an urologist in Van Training and Research Hospital between 2015- 2018. From March 2018 he has been working as an Asst. Prof. Dr. in Aksaray University School of Medicine in Aksaray.

Abdullah Gul

University of Health Sciences, Van Training and Research Hospital
Van, Van, Turkey

My name is Abdullah Gul. I was born in Keles/BURSA,Turkey at 15th september 1986. I won school of medicine at 2003.I finished this school succesfully at 2009 and worked only 3 months as a primary physician. After, I won the exam of postdoctoral training and started to work and train as a urology residency in Bagcilar training and research hospital in Istanbul. I completed this training and education at 2015 and I have worked as a urology specialist since that time.