title: Relationship Between Patient Position and Pain Severity During Shock Wave Lithotripsy for Renal Stones With the MODULITH SLX-F2 Lithotripter: A Matched Case-Control Study.
abstract: OBJECTIVE
  We evaluated the association between shock wave lithotripsy (SWL)-related pain and patient positioning during SWL.
  
  
  METHODS
  We retrospectively reviewed the medical records of 162 patients who underwent their first SWL session for single renal stones from May 2010 to August 2011. One hundred thirteen patients underwent SWL in the supine position and 49 did so in the lateral position. To evaluate an unbiased estimation of the positional effect on pain severity during SWL, both groups (supine vs. lateral) were matched according to sex, age, body mass index, stone location, and stone size. Thirty-four patients from each group were selected for analysis. Pain was evaluated with an average visual analogue scale (VAS-avg) and maximum visual analogue scale (VAS-max). Analgesic usage was also compared between the groups.
  
  
  RESULTS
  All patients (n=34) in the supine group had radio-opaque stones compared with only 47.1% of the patients in the lateral group (n=16). The VAS-avg and VAS-max of the lateral group were significantly lower than those of the supine group (1.2±1.0 and 3.1±1.7 for VAS-avg and 2.5±1.8 and 4.7±1.9 for VAS-max, respectively, p<0.05). However, analgesic usage between groups did not differ significantly (17.6% in the supine group vs. 5.9% in the lateral group, p=0.259). In a subgroup analysis confined to patients with radio-opaque stones, the supine group still suffered more pain.
  
  
  CONCLUSIONS
  Patients with renal stones suffered more SWL-related pain in the supine position than in the lateral position. During SWL, positioning of patients should be considered a predictive factor for SWL-related pain.
authors: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: Jung Hun
authors: JH
authors: Kang
authors: Sin Woo
authors: SW
authors: Lee
authors: Sung Ho
authors: SH
authors: Moon
authors: Hyun Hwan
authors: HH
authors: Sung
authors: Seol Ho
authors: SH
authors: Choo
authors: Deok Hyun
authors: DH
authors: Han
keywords: Extracorporeal shockwave lithotripsy; Kidney calculi; Patient positioning
references: Scand J Urol Nephrol. 2002;36(4):281-5
references: 12201921
references: Pain. 1985 May;22(1):1-31
references: 4011282
references: Int Urol Nephrol. 1984;16(4):273-83
references: 6336042
references: Indian J Urol. 2008 Apr;24(2):155-8
references: 19468389
references: J Pain. 2004 Sep;5(7):377-84
references: 15501195
references: Urol Int. 2005;74(1):54-7
references: 15711110
references: Curr Rheumatol Rep. 2005 Oct;7(5):342-7
references: 16174481
references: Urology. 2005 Nov;66(5):941-4
references: 16286099
references: J Urol. 1991 Aug;146(2):287-9
references: 1856917
references: Urol Res. 2009 Apr;37(2):51-3
references: 19183979
references: Anesthesiology. 2000 Apr;92(4):1049-54
references: 10754625
references: J Endourol. 2009 Dec;23(12):2021-7
references: 19821695
references: J Chin Med Assoc. 2010 Sep;73(9):477-82
references: 20875621