title: Randomized comparison of efficacy of paracetamol, lornoxicam, and tramadol representing three different groups of analgesics for pain control in extracorporeal shockwave lithotripsy.
abstract: OBJECTIVE
  Extracorporeal shockwave lithotripsy (SWL) is the mainstay treatment modality for upper urinary tract stones. However, it is a relatively painful procedure and so an efficient analgesia is required for better clinical success. The ideal method of anesthesia has not been standardized. The objective of this randomized study, for the first time in the literature, was to compare the efficacy of three common analgesics, each belonging to a different group, in pain control during SWL.
  
  
  METHODS
  In this randomized controlled study, 90 patients with upper urinary tract stones undergoing SWL were randomly divided into three groups. Group I (n = 30) received 1 g of paracetamol, group II (n = 30) received 8 mg of lornoxicam, and group III (n = 30) had 1 mg/kg of tramadol. No premedication was applied in all groups. Pain scores by visual analog scale (VAS), blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation were noted before procedure and at 1 minute and every 5 minutes during the SWL. Supplementary analgesic consumption was recorded. Moreover, all adverse effects and both patient and urologist satisfaction were documented.
  
  
  RESULTS
  Demographic parameters of the three groups were similar. All monitored parameters were also not different among the groups. The mean VAS scores at all measured times during SWL were below 4 except for two occasions, indicating a relatively efficient overall pain control provided by these three medications. Moreover, the mean VAS scores were similar among these three groups at all measured times during SWL except for those at 5 and 20 minutes at which groups III and II showed lesser pain control, respectively. No difference was observed in the amount of supplementary analgesia, which was required at higher voltages in a majority of patients. There was no significant difference in side effects.
  
  
  CONCLUSIONS
  This study suggests that paracetamol, lornoxicam, and tramadol can be safely and efficiently preferred in pain control during SWL.
authors.affiliation: Department of Anesthesia, School of Medicine, Duzce University, Duzce, Turkey.
authors.forename: Gulgun Elif
authors.initials: GE
authors.lastname: Akcali
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Iskender
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Demiraran
authors.forename: Ali
authors.initials: A
authors.lastname: Kayikci
authors.forename: Gulbin Sezen
authors.initials: GS
authors.lastname: Yalcin
authors.forename: Kamil
authors.initials: K
authors.lastname: Cam
authors.forename: Yahya Okan
authors.initials: YO
authors.lastname: Balcioglu
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D003710:Demography; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D010147:Pain Measurement; D010894:Piroxicam / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014147:Tramadol / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics; D010894:Piroxicam; D000082:Acetaminophen; D014147:Tramadol; C059451:lornoxicam