Meta-analysis of the efficacy of non-steroidal anti-inflammatory drugs vs. opioids for SWL using modern electromagnetic lithotripters

Abstract

Purpose: Clinical studies produce conflicting results on pain relief for shock wave lithotripsy (SWL). We performed a systematic review and meta-analysis to compare non-steroidal anti-inflammatory drugs (NSAIDs) and opioids in pain relief for SWL powered by an electromagnetic generator. Material and Methods: A search of MEDLINE and EMBASE was performed and all randomized controlled trials comparing NSAIDs and opioids in pain relief for SWL using modern electromagnetic lithotripters were included in the analysis. Data from 3 trials (244 patients) were pooled. The primary outcome measure was adequate analgesia, defined as "if no additional pain relief was used". The difference in the proportion of patients with adequate anesthesia was compared between the NSAIDs and opioids groups as an odds ratio and odds ratio were pooled across the 3 trials with a fixed effects model. Results: There was no statistically significant difference between using NSAIDs and opioids for pain relief during SWL using modern electromagnetic lithotripters (odds ratio 0.886, 95% CI 0.446-1,760, p = 0.730). Conclusions: Our analysis shows that in relieving pain during SWL using modern electromagnetic lithotripters NSAIDs are as effective as opioids.

Efficacy of Local Subcutaneous Anesthesia Versus Intramuscular Opioid Sedation in Extracorporeal Shockwave Lithotripsy: A Randomized Study

“…8 Active patient monitoring and continuous noninvasive pulse oximetry are essential during and up to 2 hours after the procedure. 9,14 SC infiltration in our patients was as effective as opioid analgesia with a mean VAS score of 1.64 AE 1.28 (P ¼ 0.063). Most (93.1%) patients had no, minor, or tolerable pain.…”

“…Various opioids (morphine, pethidine, tramadol, alfentanil, and fentanil) have been used with a variety of techniques (bolus IM/IV injections, patient-controlled analgesia). 9,13 The IV combination of opioids and benzodiazepines carries the risk of potential respiratory depression. 12 Both agents should be used with caution in the elderly and avoided in patients with obstructive airway disease.…”

“…9,13,18 They have a negligible effect on ventilatory control and hemodynamics, making them an attractive alternative to opioids. 8 They are associated, however, with gastrointestinal disturbances, occasional hypersensitivity reactions, and sometimes coagulation disorders because of cyclo-oxygenase inhibition.…”

“…8 They are associated, however, with gastrointestinal disturbances, occasional hypersensitivity reactions, and sometimes coagulation disorders because of cyclo-oxygenase inhibition. 4,9,18 They should also be given 30 to 60 minutes before the procedure. 13 Cutaneous infiltration anesthesia avoids safely all of these drawbacks.…”

“…4,8,9 Although opioids provide effective analgesia, they are associated with potential complications, such as respiratory depression, bradycardia, hypotension, nausea, vomiting, and prolonged recovery time. 4,9 Reports on subcutaneous (SC) anesthesia before SWL have never compared it with intramuscular (IM) opioids; instead, additional intravenous (IV) sedation was described. [10][11][12] We report a randomized study that compares the efficacy of local SC anesthesia vs routine IM opioids using a third-generation lithotripter.…”