Presentation Authors: Abdelwahab Hashem, Fady Kamal*, M. A. Elbaset, Ahmed Atwa, Mohamed Fadallah, Mahmoud Laymon, Mohammed Badawy, Magdy Elshabrawy, Mohamed Tharwat, Ebrahim Elsaeed, Mohammed Hegazy, Ahmed El-Assmy, Khaled Sheir, Hassan Abol-Enein, Mansoura, Egypt
Introduction: Although the European guidelines stated that pain control during SWL is necessary, no recommendation for proper specified analgesia, in contrast to clear one for pain relief in acute stone episode. We aim to compare the safety and efficacy of opioid sparing analgesia as xylocaine gel and ketorolac compared to pethidine for SWL pain
Methods: A single blinded RCT registered as NCT03032458; for patients&[prime] ≥ 18 years with renal and upper ureteral stones amenable to SWL. Allergy to pethidine (morphine derivative), ketorolac, or xylocaine gel and ASA score â‰¥ 4 and BMI â‰¥ 40 kg/m2 were added exclusion criteria. The 1st group 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 plus placebo gel then 30 mg IV infusion; the 3rd received lidocaine 2% gel locally plus 10 mg normal saline IV bolus then IV normal saline infusion. Numeric Pain Rating Scale (NPRS) was used for pain evaluation. A (KUB) x-ray and Ultrasound scan (US) used for stone disintegration assessment. Disintegration were classified to no (no change from basal by KUB or US), partial (fragmented and >4mm residual) and complete (â‰¤4mm residual). Computed tomography was done for patients with no residual detected.
Results: Patients&[prime] data and stone characteristics showed in table 1. For xylocaine, six session (20.7%) were aborted; so stop allocation to this arm. The median NPRS and scores were highest in xylocaine (p =0.0001) with no significant difference between ketorolac and pethedine, except at 10 min (p= 0.03) and near significant at 30 min (p=0.054) in favor of ketorolac. Stone disintegration as no, partial and complete 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 safe and more effective alternative to morphine derivatives for the SWL analgesia. Lidocaine gel shouldnâ€™t be used as mono-analgesia for SWL.