Abhirudra Mulay1, Mehul Singh2, Sharada Kumar Kankalia3, Vilas Sabale4, Vikram Satav5, Deepak Mane6, Sunil Mhaske7, Naveen Thakur8
Extracorporeal shock wave lithotripsy (ESWL) is well known for its non-invasiveness, effectiveness and minimal morbidity for the management of renal stones. Some generation of lithotripters were associated with significant pain, needing anaesthesia. In modern lithotripters, pain is insignificant making lithotripsy an outpatient procedure (day care).
The present study is aimed to compare the clinical efficacy between four drugs.
METHODS AND MATERIALS
This was a prospective study of 1000 patients with normal BMI (25-30) who underwent ESWL in the Year 2012-15 at our institute. All the patients with renal stones were randomly divided into 4 groups. Dornier Compact Sigma lithotripsy machine was used in all the patients. Group A was given IM diclofenac sodium (1 mg/kg), 60 minutes before the procedure. In group B, 10 g of EMLA cream; and in group C, 15 g of diclofenac diethylamine gel; in group D placebo (electrode gel) was applied locally.
Visual analogue scale (VAS) was used to assess the severity of pain for initial 5-10 minutes and after the procedure. A P value of less than 0.05 was considered to be statistically significant. Statistical analysis was done using one way ANOVA and results were compared between four groups.
All four groups were having comparable age, weight, stone size, number of shock waves delivered and maximum voltage used. In group A total 250 patients (M/F: 177/73), group B 250 patients (M/F: 129/121), group C 250 patients (M/F: 158/92), group D 250 patients (M/F: 162/88). With regard to pain scores, the responses were better in group B. According to location of the stones, majority of the stones were located in pelvis (41.5%), followed by upper (30.5%) and middle calyx (16.8%) and least in the lower calyx (11.2%). Overall stone free rate in our study was 75.5%, with least clearance in lower calyceal stones. 112 patients were stented prior to the procedure. Ureteroscopy and RIRS (Retrograde intrarenal surgery) was done for residual stones after 3 sessions of SWL. Post ESWL complications like pyelonephritis, steinstrasse and renal stone migrating to ureter were 2%, 4.5%, 1.9% respectively.
With regard to pain scores, the EMLA cream provided better analgesic effect as compared to other groups. Oral NSAID and occlusive dressing of EMLA offers an effective mode for achieving analgesia with minimal morbidity. This therapy avoids the need for general anaesthesia, injectable analgesics, and opioids along with their side effects.