Patient-controlled analgesia during SWL treatments

Area of Science:

• Urology
• Anesthesiology
• Nephrology

Background:

• Shockwave lithotripsy (SWL) is a common procedure for treating kidney stones.
• Effective analgesia and sedation are crucial for patient comfort and procedure success during SWL.
• Optimizing analgesic consumption can improve efficiency and reduce costs.

Purpose of the Study:

• To identify factors influencing analgesic consumption during SWL.
• To evaluate the impact of different lithotripter emitters (EMSE 220 vs. EMSE F150) on analgesic use.
• To assess the effect of reduced induction doses of propofol and alfentanil on patient-controlled analgesia (PCA) requirements.

Main Methods:

• A prospective study involving three groups of patients undergoing SWL.
• Group 1 received standard induction doses of propofol and alfentanil; Groups 2 and 3 received a 20% reduced induction dose.
• All patients received maintenance doses via a PCA device; Groups 1 and 2 used the EMSE 220 emitter, while Group 3 used the EMSE F150.

Main Results:

• Analgesic consumption was significantly lower in patients treated with the EMSE F150 emitter compared to the EMSE 220.
• Reduced induction doses did not increase PCA usage.
• Factors influencing consumption included stone location (kidney vs. ureteral), stone size, and number of shockwaves; consumption generally decreased with age.

Conclusions:

• Patient-controlled analgesia with alfentanil and propofol is a safe, reliable, and effective method for analgesosedation during SWL.
• The EMSE F150 emitter may allow for reduced analgesic consumption.
• High patient satisfaction and uncommon side effects suggest this method facilitates efficient patient throughput.