Drugs for Pain Management in Shock Wave Lithotripsy

Abstract

Objective. With this review, we provide a comprehensive overview of the main aspects and currently used drugs for analgesia in shockwave lithotripsy. Evidence Acquisition. We reviewed current literature, concentrating on newer articles and high-quality reviews in international journals. Results. No standardized protocols for pain control in SWL exist, although it is crucial for treatment outcome. General and spinal anaesthesia show excellent pain control but are only recommended for selected cases. The newer opioids and nonsteroidal anti-inflammatory drugs are able to deliver good analgesia. Interest in inhalation anaesthesia with nitrous oxide, local anaesthesia with deep infiltration of the tissue, and dermal anaesthesia with EMLA or DMSO has recently rekindled, showing good results in terms of pain control and a favourable side effect profile. Tamsulosin and paracetamol are further well-known drugs being currently investigated. Conclusion. Apart from classically used drugs like opioids and NSARs, medicaments like nitrous oxide, paracetamol, DMSA, or refined administration techniques for infiltration anaesthesia show a good effectiveness in pain control for SWL.

The Effect of Pre-Procedure Anxiety on Pain Perception During First Session of Shock Wave Lithotripsy

“…This strategy may explain the difference between our results and that of Tailly et al (14) BMI and skin-to-stone distance was relevant as expected. Their effect on VAS score was not statistically significant in our study contrary to the study by Bach et al (15). The reason might be that there was no significant difference between the body weight of our patients.…”

Transcutaneous Electric Nerve Stimulation (TENS) for pain relief during Extracorporeal Shock-Wave Lithotripsy (ESWL)

“…More side effects would be anticipated from using opioids than simple analgesics or NSAIDs. [14,15]. Still, there is no consensus on the standard analgesic regimen for controlling pain during ESWL.…”

Increased Tattoo Fading in a Single Laser Tattoo Removal Session Enabled by a Rapid Acoustic Pulse Device: A Prospective Clinical Trial

“…Other acoustic pulse devices on the market are often known as Extracorporeal Shock Wave Therapy (ESWT) devices similar to kidney stone lithotripsy devices. These often have reflectors that focus the pressure pulse into small areas about 2–3 mm in diameter at very high pressures, with risk for adjacent tissue damage and pain . Other similar devices, often considered Therapeutic Massagers, usually have slow pressure rise times, low peak pressures, and relatively low pulse rates of 10–20 per second.…”

“…In comparison, the RAP device generates planar acoustic shock wave pulses across the entire 1.3 inch diameter treatment window allowing treatment of larger areas at once, using a fast pulse rate of 100 per second, resulting in shorter treatment times. Additionally, the RAP pulses are very short in duration (100–200 nanoseconds) with fast rise and fall times to relatively high peak pressures and minimal negative pressures (some other devices have large negative pressures during each pulse cycle that cause cavitation bubbles resulting in pain ). This combination allows fast and efficient dispersion of whitening vacuoles and ink particles without discomfort or adjacent tissue damage.…”