Four analgesic techniques for shockwave lithotripsy: eutectic mixture local anesthetic is a good alternative

Area of Science:

• Anesthesiology
• Urology
• Pharmacology

Background:

• Shockwave lithotripsy (SWL) commonly utilizes various sedative and analgesic medications.
• Patient comfort and safety during SWL are paramount.
• Evaluating alternative anesthesia modalities is crucial for optimizing SWL procedures.

Purpose of the Study:

• To compare the efficacy and safety of different anesthesia options for SWL.
• To assess the effectiveness of eutectic mixture local anesthetic (EMLA) cream against traditional analgesics.
• To determine if EMLA can reduce the need for systemic analgesics like fentanyl during SWL.

Main Methods:

• A randomized study involving 100 patients undergoing SWL.
• Four groups received different pre-treatments: fentanyl (IV), diclofenac (IM), tramadol (IM), or EMLA cream (topical).
• Pain (VAS), sedation (OAS/S), and side effects were monitored; supplemental fentanyl was administered as needed.

Main Results:

• No significant differences in pain scores (VAS) or sedation levels (OAS/S) were observed among the groups.
• EMLA cream demonstrated comparable efficacy and safety to fentanyl, diclofenac, and tramadol.
• Fentanyl administration was associated with significant decreases in mean arterial pressure and oxygen saturation.

Conclusions:

• Topical EMLA cream is a safe and effective alternative for anesthesia during SWL.
• EMLA provides comparable pain relief and sedation to IV fentanyl, IM diclofenac, and IM tramadol.
• The use of EMLA may allow for a reduction in the required dose of fentanyl during SWL.