Eutectic mixture of local anaesthetics for pain reduction during extracorporeal shockwave lithotripsy: A systematic review and meta-analysis

Abstract

A systematic review and meta-analysis was conducted to explore the effect of a eutectic mixture of local anaesthetics (EMLA) on pain reduction during extracorporeal shockwave lithotripsy (ESWL). PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases (updated March 2020) were searched for randomised controlled trials (RCTs) assessing the effect of EMLA for patients that underwent ESWL. The search strategy and study selection process were managed according to the PRISMA statement. Six RCTs were included in the meta-analysis. Overall, the results indicated that EMLA significantly reduced pain compared to the control group (RR =-2.98, 95% CI =-5.82 to-0.13, P = 0.04) with a heterogeneity of I 2 = 57% (P = 0.04). Subgroup analysis showed that EMLA did not significantly reduce pain when the patients took an analgesic premedication (RR =-1.46, 95% CI =-5.89 to 2.98, P = 0.52) with a heterogeneity of I 2 = 38% (P = 0.52). Conversely, studies without premedication showed a significant pain relief effect (RR =-4.08, 95% CI =-7.36 to-0.65, P =-0.80) with a heterogeneity of I 2 = 48% (P = 0.14). Most studies showed there was no difference in the patient's need for analgesics. EMLA was effective for reducing pain during EWSL. However, this analgesic effect was limited and did not reduce the need for analgesics.

Efficacy of acupuncture for pain relief in patients receiving extracorporeal shock wave lithotripsy: a meta-analysis of randomized controlled studies

“…For pain relief, previous studies have suggested the use of topical anesthetic creams such as EMLA (6), which can penetrate the skin to a depth of 4 mm. However, the analgesic effect of topical anesthetics did not reduce the need for analgesia as shown in previous RCT (60) and meta-analysis (61). The result may be explained by the inadequacy of topical anesthesia to alleviate both deep somatic pain and visceral pain (62).…”