Local anesthesia for extracorporeal shock wave lithotripsy: a double-blind, prospective, randomized study

Area of Science:

• Urology
• Anesthesiology
• Nephrology

Background:

• Extracorporeal shock wave lithotripsy (ESWL) is a common procedure for kidney and ureteral stones.
• Pain management during ESWL is crucial for patient comfort and procedural success.
• The role of local anesthesia in mitigating analgesic needs during ESWL requires further investigation.

Purpose of the Study:

• To evaluate the efficacy of local anesthesia in reducing intravenous analgesic requirements during ESWL.
• To compare analgesic needs in patients undergoing ESWL with and without local anesthesia.
• To assess the impact of stone location (ureteral vs. renal) on analgesic requirements.

Main Methods:

• A randomized controlled trial involving 69 patients (ASA I-II) undergoing ESWL with a second-generation lithotriptor.
• Subcutaneous infiltration with lidocaine 1% plus epinephrine or a saline placebo prior to the procedure.
• Patients were stratified into four groups based on stone location (ureteral or renal) and treatment (local anesthetic or placebo).

Main Results:

• Patients with ureteral stones required higher doses of intravenous analgesics compared to those with renal stones.
• No significant reduction in intravenous analgesic requirements was observed in patients who received local anesthesia compared to the placebo groups.
• Local anesthesia did not demonstrate a statistically significant benefit in decreasing pain medication needs during ESWL.

Conclusions:

• Local anesthesia, when administered via subcutaneous infiltration, does not decrease the requirement for intravenous analgesics during ESWL with a second-generation lithotriptor.
• The findings suggest that current local anesthetic techniques may not be sufficient to alter systemic analgesic demands in ESWL.
• Further research may explore alternative or adjunct pain management strategies for ESWL procedures.