title: Petroleum jelly is an ideal contact medium for pain reduction and successful treatment with extracorporeal shock wave lithotripsy.
abstract: OBJECTIVE
  Various minimally invasive approaches to reduce pain during extracorporeal shock wave lithotripsy (ESWL) have been described. We compared petroleum jelly (Vaselinet) and ultrasound gel in vitro as a contact medium based on the stone fragmentation rate. The analgesic effect of cutaneous petroleum jelly was tested against eutectic mixture of local anesthesia. We also evaluated the outcome of ESWL in a large group of patients treated with petroleum jelly.
  
  
  METHODS
  In vitro 3 artificial stones were completely fragmented with a MFL 5000* lithotriptor using petroleum jelly or ultrasound gel as a contact medium. A total of 110 patients (group 1) received petroleum jelly before treatment with the same lithotriptor. After retrospective analysis of group 1 we matched 32 patients (group 2) receiving cutaneous eutectic mixture of local anesthesia. Because of the favorable results with petroleum jelly, we used it in another 148 patients, for a total of 258 patients (group V). Treatment dependent pain was scored using a questionnaire as 1--no, 2--minor, 3--tolerable and 4--intolerable. ESWL without additional analgesics had a pain score of 1 to 3.
  
  
  RESULTS
  In vitro petroleum jelly had a superior fragmentation rate compared to ultrasound gel. Our long-term experience with the lithotriptor indicated that only 30% of patients required no additional analgesics with cutaneous ultrasound gel. In contrast, no additional analgesics were needed in only 38% of group 2 compared to 81.8% of group V. The stone fragmentation rate did not differ statistically between groups.
  
  
  CONCLUSIONS
  Cutaneous petroleum jelly offers a noninvasive, highly effective, inexpensive treatment modality with no side effects and significant reduction in pain. This ointment is our contact medium of choice.
authors.affiliation: Department of Urology, Medizinische Hochschule Hannover, Germany.
authors.forename: A J
authors.initials: AJ
authors.lastname: Becker
authors.forename: C G
authors.initials: CG
authors.lastname: Stief
authors.forename: M C
authors.initials: MC
authors.lastname: Truss
authors.forename: M
authors.initials: M
authors.lastname: Oelke
authors.forename: S
authors.initials: S
authors.lastname: Machtens
authors.forename: U
authors.initials: U
authors.lastname: Jonas
mesh_terms: D000779:Anesthetics, Local; D004643:Emollients / Q000627:therapeutic use*; D005782:Gels; D006801:Humans; D008012:Lidocaine; D000077442:Lidocaine, Prilocaine Drug Combination; D008096:Lithotripsy / Q000009:adverse effects*; D008875:Middle Aged; D010146:Pain / Q000209:etiology* / Q000517:prevention & control*; D010577:Petrolatum / Q000627:therapeutic use*; D011318:Prilocaine; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D000779:Anesthetics, Local; D004643:Emollients; D005782:Gels; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D010577:Petrolatum; D008012:Lidocaine