Intravenous paracetamol versus oral tramadol for pain control during shockwave lithotripsy: a prospective randomized comparative study

Abstract

Objectives: Shock wave lithotripsy SWL is a simple, effective, and minimally invazive treatment option for urinary tract stone disease. Nevertheless, pain during the SWL procedure is one of the most common restriction factor for this treatment modality.We aimed to compare the efficacy and adverse effects of intravenous IV paracetamol and oral tablet tramadol for pain control during SWL procedure. Material and Methods: We enrolled 54 patients with the indication of SWL therapy in this prospective randomized comparative study. 1 g IV paracetamol infusion was applied to group I n:28 and 100 mg oral tramadol was applied to group II n:26 . The pain was measured by 10-point visual analog scale VAS . 1 mg/kg of body weight intramuscular pethidine meperidine was applied when supplemental analgesia required. Results: The mean VAS score was significantly lower in group I patients than in group II at 5, 10, 15, 30, 40th minutes during lithotripsy P=0.011, P=0.009, P=0.001, P=0.000, P=0.000, respectively . Supplementary analgesic requirement was higher in group I than group II which received more shockwaves or higher voltages. However, this difference was not statistically significant P=0.199 . Conclusions: This is the first study comparing the analgesic effects of IV paracetamol and oral tramadol for pain control during SWL in the literature. IV paracetamol provides better analgesia than oral tramadol with minimal side effects. However, a minimal increase in supplemental analgesia requirement should be considered in patients who will receive more shockwaves or higher voltages

Keywords

• Analgesia
• extracorporal shockwave lithotripsy
• paracetamol
• tramadol
• pain

Şok dalga litotripsi sırasındaki ağrı kontrolünde intravenöz parasetamole karşın oral tramadol: prospektif, randomize, karşılaştırmalı çalışma

Abstract

Amaç: Şok dalga litotripsi SWL üriner sistem taş hastalığının tedavisinde kolay, etkili ve minimal invaziv bir tedavi seçeneğidir. Bununla beraber, SWL işlemi sırasında hastanın duyduğu ağrı bu tedavi seçeneğini kısıtlayan en önemli faktördür. SWL işlemi sırasındaki ağrının kontrolü için intravenöz IV parasetamol ile oral tablet tramadolün etkinliğini ve yan etkilerini karşılaştırdık. Gereç ve Yöntemler: Bu prospektif randomize karşılaştırmalı çalışmaya SWL tedavisi endikasyonu olan 54 hasta dahil edildi. Grup I n:28 ’ deki hastalara 1 g IV parasetamol infüzyonu uygulanırken grup II n:26 ’ deki hastalara 100 mg oral tramadol verildi. Ağrı düzeyi 10’luk vizüel analog skala VAS ile ölçüldü. Ek analjezi gereksinimi olduğunda 1 mg/kg dozunda intramüsküler petidin meperidin uygulandı. Bulgular: Litotripsi işlemi sırasında 5, 10, 15, 30 ve 40. Dakikalardaki ortalama VAS skorları grup I’deki hastalarda grup II’deki hastalara kıyasla anlamlı olarak daha düşüktü sırasıyla, P=0.011, P=0.009, P=0.001, P=0.000, P=0.000 . Ek analjezik gereksinimi, daha fazla şok dalgasına ve voltaja maruz kalan grup I’deki hastalarda grup II’dekilerden daha fazlaydı. Fakat bu fark istatistiksel olarak anlamlı değildi P=0.199 . Sonuç: Bu çalışma SWL işlemi sırasında IV parasetamol ile oral tramadolün analjezik etkinliğini karşılaştıran literatürdeki ilk araştırmadır. IV parasetamol, minimal yan etki ile oral tramadolden daha iyi analjezik etkinlik göstermektedir. Bununla birlikte daha fazla şok dalgası ve daha yüksek voltaj uygulanacak hastalarda az da olsa ek analjezik ihtiyacı olabileceği göz önünde bulundurulmalıdır

Keywords

• Analjezi
• vücut dışı şok dalga litotripsi
• parasetamol
• tramadol
• ağrı

References

1. Issa MM, El-Galley R, McNamara DE, Segall S. Analge- sia during extracorporeal shock wave lithotripsy using the Medstone STS lithotriptor: a randomized prospective study. Urology 1999;54:625-8.
2. Akcali GE, Iskender A, Demiraran Y, et al. Randomized comparison of efficay of paracetamol, lornoxicam, and tramadol representing three different groups of analgesics for pain control in extracorporeal shockwave lithotripsy. J Endourol 2010;24:615-20.
3. Berwin JT, El-Husseiny T, Papatsoris AG, Hajdinjak T, Masood J, Buchholz N. Pain in extracorporeal shock wave lithotripsy. Urol Res 2009;37:51-3.
4. Bach C, Zaman F, Kachrilas S, Kumar P, Buchholz N, Ma- sood J. Drugs for pain management in shock wave lithot- ripsy. Pain Res Treat 2011;2011:259426.
5. Wickham JE. Treatment of urinary tract stones. BMJ 1993;307:1414-7.
6. Hosking MP, Morris SA, Klein FA, Dobmeyer-Dittrich C. Anesthetic management of patients receiving calculus therapy with a third-generation extracorporeal lithotripsy machine. J Endourol 1997;11:309-11.
7. Kumar A, Gupta NP, Hemal AK, Wadhwa P. Comparison of three analgesic regimens for pain control during shock- wave lithotripsy using Dornier Delta Compact lithotripter: a randomized clinical trial. J Endourol 2007;21:578-82.
8. Saita A, Bonaccorsi A, Aquilino M, Guzzardi F, Lazzara A, Motta M. ESWL: comparing two analgesic techniques. Our experience Urol Int 2004;72:46–7.

9. Medina HJ, Galvin EM, Dirckx M, et al. Remifentanil as a single drug for extracorporeal shock wave lithotripsy: a comparison of infusion doses in terms of analgesic po- tency and side effects. Anesth Analg 2005;101:365–70.
10. Kaygusuz K, Gokce G, Gursoy S, Ayan S, Mimaroglu C, Gultekin Y. A comparison of sedation with dexmedetomi- dine or propofol during shockwave lithotripsy: a randomi- zed controlled trial. Anesth Analg 2008;106:114–9.
11. Ozkan F, Erdemir F, Erkorkmaz U, Kaya Z, Senayli Y, Par- laktas BS. Comparison of three different analgesic proto- cols during shockwave lithotripsy. J Endourol 2012;26:691- 6. extracorporeal piezolithotripsy. J Adv Nurs 1990;15:1078- 82.
12. Takmaz SA, Inan N, Goktug A, Erdogan I, Sunay M, Cey- han A. The analgesic effect of 8 and 16mg lornoxicam ad- ministered before shock wave lithotripsy: a randomized, doubleblind, controlled study. Urology 2008;72:282–5.
13. Yilmaz E, Batislam E, Basar MM, Tuglu D, Ferhat M, Ba- sar H. Effectiveness of eutectic mixture of local anaesthetic cream and occlusive dressing with low dosage of fentanyl for pain control during shock wave lithotripsy. J Endourol 2005;19:589–94.
14. Schelling G, Weber W, Mendl G, Braun H, Cullmann H. Patient controlled analgesia for shock wave lithotripsy: the effect of self-administered alfentanil on pain intensity and drug requirement. J Urol 1996;155:43–7.
15. Tu J, Matula TJ, Bailey MR, Crum LA. Evaluation of a shock wave induced cavitation activity both in vitro and in vivo. Phys Med Biol 2007;52:5933–44.
16. Weber A, Koehrmann KU, Denig N, Michel MS, Alken P. What are the parameters for predictive selection of pati- ents requiring anesthesia for extracorporeal shockwave lithotripsy? Eur Urol 1998;34:85-92.
17. Mezentsev VA. Meta-analysis of the efficacy of non- steroidal anti-inflammatory drugs vs. opioids for SWL using modern electromagnetic lithotripters. Int Braz J Urol 2009;35:293–8.
18. Parkin J, Keeley FX Jr, Timoney AG. Analgesia for shock wave lithotripsy. J Urol 2002;167:1613–5.
19. Monk TG, Bouré B, White PF, Meretyk S, Clayman RV. Comparison of intravenous sedative-analgesic techni- ques for outpatient immersion lithotripsy. Anesth Analg 1991;72:616–21.
20. Yang CP, Cheng CH, Wong CS, Ho ST. Effects of intrave- nous ketorolac and fentanyl combined with midazolam on analgesia and side effects during extracorporeal shock wave lithotripsy. Acta Anaesthesiol Sin 2002;40:9–12.
21. Dawson C, Vale JA, Corry DA, et al. Choosing the cor- rect pain relief for extracorporeal lithotripsy. Br J Urol 1994;74:302–7.
22. Yilmaz E, Batislam E, Basar M, Tuglu D, Yuvanc E. Can prilocaine infiltration alone be the most minimally invasi- ve approach in terms of anesthesia during extracorporeal shock wave lithotripsy? Urology 2006;68:24–7.
23. Rogenhofer S, Wimmer K, Blana A, Roessler W, Wieland WF, Filbeck T. Acupuncture for pain in extracorporeal shock-wave lithotripsy. J Endourol 2004;18:634–7.
24. Bonnefont J, Courade JP, Alloui A, Eschalier A. [Antino- ciceptive mechanism of action of paracetamol.] Drugs 2003;63:1–4.
25. Driessen B, Reimann W. Interaction of the central analge- sic, tramadol, with the uptake and release of 5-hydroxytr- yptamine in the rat brain in vitro. Br J Pharmacol 1992;105:147–51.
26. Sá Rêgo MM, Inagaki Y, White PF. Remifentanil administ- ration during monitored anesthesia care: are intermittent boluses an effective alternative to a continuous infusion? Anesth Analg 1999;88:518-22.
27. Andréou A, Sibert L, Montes R, Hacpille L, Pfister C, Grise P. [Randomized study comparing piroxicam analgesia and tramadol analgesia during outpatient electromagnetic ext- racorporeal lithotripsy.] Prog Urol 2006;16:155-9.
28. Peduto VA, Ballabio M, Stefanini S. Efficacy of propace- tamol in the treatment of postoperative pain. Morphi- ne-sparing effect in orthopedic surgery. Italian Collabo- rative Group on Propacetamol. Acta Anaesthesiol Scand 1998;42:293–8.
29. Chia YY, Liu K. Prospective and randomized trial of intra- venous tenoxicam versus fentanyl and tramadol for anal- gesia in outpatient extracorporeal lithotripsy. Acta Anaest- hesiol Sin 1998:36;17-22.