The opioid-sparing effect of diclofenac sodium in outpatient extracorporeal shock wave lithotripsy (ESWL).
OBJECTIVE
To evaluate the opioid-sparing and analgesic effect of diclofenac sodium in ambulatory nonimmersion extracorporeal shock wave lithotripsy (ESWL).


METHODS
Randomized, double-blind, placebo-controlled study.


METHODS
Large referral hospital.


METHODS
Twenty-seven ASA physical status I and II patients with upper renal tract nephrolithiasis.


METHODS
ESWL was performed with a sedative-analgesic technique. Diclofenac sodium 75 mg or an equal volume of saline was given intramuscularly 45 minutes prior to the procedure. Fentanyl and midazolam were added to maintain adequate sedation and analgesia.


RESULTS
Demographically, both groups were comparable. In the diclofenac sodium group, heart rate was slightly higher, treatment time was shorter, more shock waves were administered (p < 0.02), and less fentanyl was required (p < 0.02). Mean arterial pressure was lower and arterial oxygen saturation by pulse oximeter was higher in the diclofenac sodium group. There were no differences between the groups in voltage, stone size, fragmentation, dose of midazolam administered, or overall assessment by both the doctors and patients.


CONCLUSIONS
Patients administered diclofenac sodium received a greater number of shock waves, required less fentanyl, and showed a marginal improvement in hemodynamic stability and oxygenation during ambulatory nonimmersion ESWL.
Fredman
B
B
Department of Anesthesiology and Intensive Care, Meir Hospital, Kfar Sava, Israel.
Jedeikin
R
R
Olsfanger
D
D
Aronheim
M
M
D000328:Adult; D000698:Analgesia; D000701:Analgesics, Opioid; D000771:Anesthesia, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D004008:Diclofenac / Q000008:administration & dosage / Q000494:pharmacology; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000494:pharmacology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives; D007669:Kidney Calculi / Q000628:therapy; D008096:Lithotripsy / Q000379:methods; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000494:pharmacology; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010919:Placebos
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D010919:Placebos; D004008:Diclofenac; D008874:Midazolam; D010100:Oxygen; D005283:Fentanyl