Efficacy of pethidine, ketorolac, and lidocaine gel as analgesics for pain control in shockwave lithotripsy: A single-blinded randomized controlled trial
Purpose: To compare the safety and efficacy of xylocaine gel and ketorolac as opioid-sparing analgesia compared with pethidine for shock wave lithotripsy (SWL) pain. Materials and Methods: A single-blinded randomized controlled trial (RCT) was performed in 132 patients with renal and upper ureteral...
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| Format: | Article |
| Language: | English |
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Korean Urological Association
2019-07-01
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| Series: | Investigative and Clinical Urology |
| Subjects: | |
| Online Access: | https://www.icurology.org/Synapse/Data/PDFData/2020ICU/icu-60-251.pdf |
| _version_ | 1811297458813140992 |
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| author | Abdelwahab Hashem Fady K. Ghobrial M. A. Elbaset Ahmed M. Atwa Mohamed Fadallah Mahmoud Laymon Ahmed El-Assmy Khaled Z. Sheir Hassan Abol-Enein |
| author_facet | Abdelwahab Hashem Fady K. Ghobrial M. A. Elbaset Ahmed M. Atwa Mohamed Fadallah Mahmoud Laymon Ahmed El-Assmy Khaled Z. Sheir Hassan Abol-Enein |
| author_sort | Abdelwahab Hashem |
| collection | DOAJ |
| description | Purpose: To compare the safety and efficacy of xylocaine gel and ketorolac as opioid-sparing analgesia compared with pethidine for shock wave lithotripsy (SWL) pain. Materials and Methods: A single-blinded randomized controlled trial (RCT) was performed in 132 patients with renal and upper ureteral stones amenable to treatment with SWL. The first patient group received intravenous (IV) pethidine and placebo gel; the second group received IV ketorolac plus placebo gel; the third group received lidocaine gel locally plus normal saline IV. Stone disintegration was classified as none (no change from basal by kidney, ureter, bladder X-ray or ultrasound [US] imaging), partial (fragmented and >4-mm residual fragments), and complete (≤4-mm residual fragments). Stone disintegration was assessed by kidney-ureter-bladder X-ray and US imaging. Pain was evaluated by use of the Numeric Pain Rating Scale (NPRS). Results: The NPRS scores were highest in the xylocaine group at 10, 20, and 30 minutes (p=0.0001) with no significant difference between the ketorolac and pethidine groups, except at 10 minutes (p=0.03) and a near significant difference at 30 minutes (p=0.054) in favor of ketorolac. Results for stone disintegration (none, partial, and complete, respectively) were as follows: 25 (50.0%), 23 (46.0%), and 2 (4.0%) for pethidine; 19 (35.8%), 23 (43.4%), and 11 (20.8%) for ketorolac; and 26 (89.7%), 3 (10.3%), and 0 (0.0%) for lidocaine (p=0.008). Conclusions: Ketorolac is a safe and more effective alternative to morphine derivatives for SWL analgesia. Lidocaine gel should not be used as mono-analgesia for SWL. |
| first_indexed | 2024-04-13T06:04:36Z |
| format | Article |
| id | doaj.art-d38de0b560504241831de7c989450f74 |
| institution | Directory Open Access Journal |
| issn | 2466-0493 2466-054X |
| language | English |
| last_indexed | 2024-04-13T06:04:36Z |
| publishDate | 2019-07-01 |
| publisher | Korean Urological Association |
| record_format | Article |
| series | Investigative and Clinical Urology |
| spelling | doaj.art-d38de0b560504241831de7c989450f742022-12-22T02:59:18ZengKorean Urological AssociationInvestigative and Clinical Urology2466-04932466-054X2019-07-0160425125710.4111/icu.2019.60.4.251Efficacy of pethidine, ketorolac, and lidocaine gel as analgesics for pain control in shockwave lithotripsy: A single-blinded randomized controlled trialAbdelwahab Hashem0Fady K. Ghobrial1M. A. Elbaset2Ahmed M. Atwa3Mohamed Fadallah4Mahmoud Laymon5Ahmed El-Assmy6Khaled Z. Sheir7Hassan Abol-Enein8Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.Purpose: To compare the safety and efficacy of xylocaine gel and ketorolac as opioid-sparing analgesia compared with pethidine for shock wave lithotripsy (SWL) pain. Materials and Methods: A single-blinded randomized controlled trial (RCT) was performed in 132 patients with renal and upper ureteral stones amenable to treatment with SWL. The first patient group received intravenous (IV) pethidine and placebo gel; the second group received IV ketorolac plus placebo gel; the third group received lidocaine gel locally plus normal saline IV. Stone disintegration was classified as none (no change from basal by kidney, ureter, bladder X-ray or ultrasound [US] imaging), partial (fragmented and >4-mm residual fragments), and complete (≤4-mm residual fragments). Stone disintegration was assessed by kidney-ureter-bladder X-ray and US imaging. Pain was evaluated by use of the Numeric Pain Rating Scale (NPRS). Results: The NPRS scores were highest in the xylocaine group at 10, 20, and 30 minutes (p=0.0001) with no significant difference between the ketorolac and pethidine groups, except at 10 minutes (p=0.03) and a near significant difference at 30 minutes (p=0.054) in favor of ketorolac. Results for stone disintegration (none, partial, and complete, respectively) were as follows: 25 (50.0%), 23 (46.0%), and 2 (4.0%) for pethidine; 19 (35.8%), 23 (43.4%), and 11 (20.8%) for ketorolac; and 26 (89.7%), 3 (10.3%), and 0 (0.0%) for lidocaine (p=0.008). Conclusions: Ketorolac is a safe and more effective alternative to morphine derivatives for SWL analgesia. Lidocaine gel should not be used as mono-analgesia for SWL.https://www.icurology.org/Synapse/Data/PDFData/2020ICU/icu-60-251.pdfAnalgesiaKetorolacLithotripsy |
| spellingShingle | Abdelwahab Hashem Fady K. Ghobrial M. A. Elbaset Ahmed M. Atwa Mohamed Fadallah Mahmoud Laymon Ahmed El-Assmy Khaled Z. Sheir Hassan Abol-Enein Efficacy of pethidine, ketorolac, and lidocaine gel as analgesics for pain control in shockwave lithotripsy: A single-blinded randomized controlled trial Investigative and Clinical Urology Analgesia Ketorolac Lithotripsy |
| title | Efficacy of pethidine, ketorolac, and lidocaine gel as analgesics for pain control in shockwave lithotripsy: A single-blinded randomized controlled trial |
| title_full | Efficacy of pethidine, ketorolac, and lidocaine gel as analgesics for pain control in shockwave lithotripsy: A single-blinded randomized controlled trial |
| title_fullStr | Efficacy of pethidine, ketorolac, and lidocaine gel as analgesics for pain control in shockwave lithotripsy: A single-blinded randomized controlled trial |
| title_full_unstemmed | Efficacy of pethidine, ketorolac, and lidocaine gel as analgesics for pain control in shockwave lithotripsy: A single-blinded randomized controlled trial |
| title_short | Efficacy of pethidine, ketorolac, and lidocaine gel as analgesics for pain control in shockwave lithotripsy: A single-blinded randomized controlled trial |
| title_sort | efficacy of pethidine ketorolac and lidocaine gel as analgesics for pain control in shockwave lithotripsy a single blinded randomized controlled trial |
| topic | Analgesia Ketorolac Lithotripsy |
| url | https://www.icurology.org/Synapse/Data/PDFData/2020ICU/icu-60-251.pdf |
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