Comparative study between three analgesic agents for the pain management during extracorporeal shock wave lithotripsy.
OBJECTIVE
To compare the clinical efficacy between locally applied diclofenac diethylamine gel, EMLA cream and systemically given diclofenac sodium for the pain relief during extracorporeal shock wave lithotripsy (SWL) using Dornier Delta Compact Lithotripter.


METHODS
One hundred five patients with renal stones were randomly divided in to 3 groups. Group A was given intramuscular diclofenac sodium (1 mg/kg), 45 minutes before the procedure. In group B, 10 gm of eutectic mixture of local anesthetic (EMLA) cream and in group C, 15 gm of diclofenac diethylamine gel was applied locally 45 minutes before the procedure. Ten-score linear and visual analogue scale (VAS) was used to assess the severity of pain during the procedure. Analysis of variance (ANOVA) test was used to compare various parameters and analyzed statistically.


RESULTS
All the three groups were not statistically different with respect to age, weight, stone size, number of shock wave delivered and maximum voltage used (P > .05). The mean pain score in group A was 4.48, in group B was 3.60 and in group C was 3.95, which were not significantly different (P = 1.34). Complication like skin lesion was found only in injection diclofenac sodium group whereas cold sensation at the local site was typically found in diclofenac diethylamine gel group.


CONCLUSIONS
Although not statistically significant, the mean pain score in locally applied analgesic agents (EMLA and diclofenac diethylamine gel) is lower as compared to intramuscularly given diclofenac sodium. Among these two locally acting drugs, diclofenac diethylamine gel is an equally effective alternative to EMLA.
Yun-Jiang Zang, Department of Urologic Surgery, Weifang People's Hospital, 151 Guangwen Street, Kuiwen District, Weifang, Shandong, China. yunshanzang@gmail.com.
Jianjun
J
Liu
Yun-Jiang
YJ
Zang
D000328:Adult; D000698:Analgesia; D000779:Anesthetics, Local / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D004008:Diclofenac / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use*; D000077442:Lidocaine, Prilocaine Drug Combination; D008096:Lithotripsy / Q000009:adverse effects*; D008297:Male; D010146:Pain / Q000209:etiology*; D059408:Pain Management; D011318:Prilocaine / Q000627:therapeutic use*; D011446:Prospective Studies
D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D004008:Diclofenac; D008012:Lidocaine