Background and Goal of Study: Extracorporal shockwave lithotripsy (ESWL) represents the initial treatment modality in approximately 90% of patients with urinary tract. Various sedative and analgesic medication has been used for ESWL1. The aim of this study was to compare the analgesic and side effects of propofol in combination with fentanyl or lornoxicam in ESWL.
Material and Methods: After approval of the local ethics committee and written informed consent were obtained, 23 patients (ASA class I-II, aged 25-59yr) undergoing elective ESWL (using Siemens Lithostar ESWL lithotriptor) were included in the study. After arriving in the anaesthetic room and insertion of an i.v. cannula, baseline assessments of heart rate (ECG), noninvasive arterial pressure and pulse oximetry (SpO2), were performed. In all patient, 0.5mgkg of propofol was administered intravenously before ESWL. The patients were randomly allocated to receive either a bolus of 1 μg kg−1 fentanyl followed by a continuous infusion of propofol at a rate of 1 mg kg h−1 (Group PF; n = 12) or a bolus of 8 mg lornoxicam followed by a continuous infusion of propofol at a rate of 1 mg kg h−1 (Group PL; n = 11). Pain intensity was evaluated on a 0-100-mm visual analog scale (VAS). A supplemental analgesia with intravenous fentanyl 25 μgr or 8 mgr lornoxicam was given when inadequate analgesia occurred (VAS > 3). Pain intensity (using VAS), the level of sedation (using the four-point score) and analgesic requirement were recorded. Respiratory depression during the procedure is treated with oxygen supplementation. Statistical analysis were the performed by using Independent Simplest test, Chi-square test and Mann Whitney U test. p < 0.05 was considered at statistically significant.
Results: There was no statistical differences between two groups in the demographic data, duration of ESWL procedure and hemodynamic parameters during ESWL In group PF, the sedation scores were significantly higher than group PL (p < 0.05). The requirement of additional analgesic was higher in group PF than in group PL (5 versus 1 patients, p < 0.05). The incidence of oxygen supplement was lower in PL group (n = 1; 9% patient) compared with that of PF group (n = 8; 66.7%) (p < 0.05).
Discussion and Conclusion:In conclusion, propofol-lornoxicam combination was found to be a better alternative for ESWL patients since this combination caused less respiratory depression and decreased the analgesic necessity.
1 Br J Of Anaesth 2002 Oct; 89(4):567-571.