Abstract
The aim of this study was to compare the clinical efficacy of electro-acupuncture (EA) with the combination of tramadol+midazolam (TM) for pain relief during outpatient extracorporeal shockwave lithotripsy (ESWL). A total of 35 patients (20 men, 15 women) with stones located in the pelvicalyceal system of the kidney were randomized prospectively to undergo lithotripsy with a third generation lithotriptor (Stone Lith, smart PCK) after receiving either EA (n=17) or TM (n=18) for sedation and analgesia. EA treatment was applied to patients by the same licensed acupuncturist 30 min prior to ESWL in group EA. Tramadol (1.5 mg/kg) 30 min before the start of lithotripsy and midazolam (0.06 mg/kg) 5 min prior to ESWL were given as a sedo-analgesic intravenously to group TM. During ESWL, blood pressure, heart rate, pain and sedation levels were measured at baseline and every 15 min thereafter. The pain intensity perceived during lithotripsy was evaluated using a visual analog scale (VAS). There was no statistical differences in the diameters of the stones and age of the patients between groups (P=0.590; P=0.568, respectively). In the EA group, the median of maximum energy level achieved was 16.0 kV (range 10–23 kV), while it was 18.0 kV (range 10–20 kV) in the TM group. There was no statistically significant difference between the maximum energy levels applied to the patients during ESWL (P=0.613). The median numbers of shockwaves were 2,114 (range 1,100–3,800) and 2,200 (range 1,500–3,200) in the EA and TM groups, respectively. In the TM group, the numbers of shockwaves used were higher than in group EA during ESWL. However, this difference was not significant (P=0.732). VAS scores were consistently lower in the EA group compared with the TM group throughout the ESWL procedure. The median VAS score was 5.0 (range 1–10) in the EA group while it was 8.0 (range 2–10) in the TM group. The patients who underwent EA had lower median scores of VAS than patients who took only conservative treatment, but this difference was not significant (P=0.245). When both groups were compared for stone-free rates, no significant difference was found [82.3% (14/17) for group EA, 88.8% (16/18) for group TM] (P=0.658). Durations of ESWL procedures were similar in both groups [median 27.4 min (range 15.7–34.3) in group EA vs 27.1 min (range 16.1–33.6) in group TM] (P=0.517). No side effects was seen in any patient who received EA. Side effects such as mild orthostatic hypotension and dizziness occurred in patients given sedo-analgesia, but these were not severe enough to require any patient to be excluded from the study. Our study shows that EA is an effective method for inducing sedation with analgesia without any demonstrable side effects.
Similar content being viewed by others
References
Stoller ML (2000) Extracorporeal shock wave lithotripsy. In: Tanago EA, McAninch JW (eds), Smith’s general urology, 15th edn. Mc Graw-Hill, San Francisco, p 321
Chaussy C, Schmiedt E, Jocham D, Brendel W, Forssmann B, Walther V (1982) First clinical experience with extracorporeally induced destruction of kidney stones by shock waves. J Urol 127: 417
Chin CM, Tay KP, NG FC, Lim PH, Chng HC (1997) Use of patient-controlled analgesia in extracorporeal shockwave lithotripsy. Br J Urol 79: 848
Ozcan S, Yilmaz E, Buyukkocak U, Basar H, Apan A (2002) Comparison of three analgesics for extracorporeal shock wave lithotripsy. Scand J Urol Nephrol 36: 281
Ganapathy S, Razvi H, Moote C, Parkin J, Yee I, Gverzdys S, Dain S, Denstedt JD (1996) Eutectic mixture of local anaesthetics is not effective for extracorporeal shock wave lithotripsy. Can J Anaesth 43: 1030
Aybek Z, Turan T, Yonguc T, Bozbay C, Atahan O, Tuncay OL (1998) Requirement of analgesia for extracorporeal shock wave lithotripsy and efficacy of a nonsteroidal antiinflammatory drug: piroxicam. 34: 207
Jensen MP, Chen C, Brugger AM (2000) Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain 4: 407
Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27: 117
Tauzin-Fin P, Delort-Laval S, Krol-Houdek MC, Maurette P, Bannwarth B (1998) Effect of balanced analgesia with buprenorphine on pain response and general anaesthesia requirement during lithotripsy procedures. Eur J Anaesthesiol 15: 147
Loening S, Kramolowsky EV, Willoughby B (1987) Use of local anesthesia for extracorporeal shock wave lithotripsy. J Urol 137: 626
Bierkens AF, Maes RM, Hendrikx JM, Erdos AF, De Vries JD, DebruyneFM (1991) The use of local anesthesia in second generation extracorporeal shock wave lithotripsy: eutectic mixture of local anesthetics. J Urol 146: 287
Fredman B, Jedeikin R, Olsfanger D, Aronheim M (1993) The opioid-sparing effect of diclofenac sodium in outpatient extracorporeal shock wave lithotripsy (ESWL). J Clin Anesth 5: 141
Monk TG, Rater JM, White PF (1991) Comparison of alfentanil and ketamine infusions in combination with midazolam for outpatient lithotripsy. Anesthesiology 74: 1023
Hennies HH, Friderichs E, Wilsmann K, Flohe L (1982) Effect of the opioid analgesic tramadol on inactivation of norepinephrine and serotonin. Biochem Pharmacol 31: 1654
Rasmussen YH, Dahl C (1994) Analgesic requirements for ESWL treatment. A double blind study. Scand J Urol Nephrol 28: 225
Johnstone PA, Issa MM (2004) Acupuncture in conventional practice. J Endourol 18: 127
Quatan N, Bailey C, Larking A, Boyd PJ, Watkin N (2003) Sticks and stones: use of acupuncture in extracorporeal shockwave lithotripsy. J Endourol 17(: 867
Stux G, Pomeranz B (1988) Basics of acupuncture. Springer, Heidelberg Berlin p 4
NIH Consensus Development Panel on Acupuncture. (1998) JAMA 280 : 1518
Honjo H, Kamoi K, Naya Y, Ukimura O, Kojima M, Kitakoji H, Miki T (2004) The effects of acupuncture for chronic pelvic pain syndrome with intrapelvic congestion. Int J Urol 11: 607
Yin G, Liu Zhenghua (2000) Advanced modern chinese acupuncture therapy. New World Press, Beijing
Dawson C, Vale JA, Corry DA, Cohen NP, Gallagher J, Nockler IB, Whitfield HN (1994) Choosing the correct pain relief for extracorporeal lithotripsy. Br J Urol 74: 302
Acknowledgement
This work was supported by the Kahramanmaras Sutcu Imam University Research Foundation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Resim, S., Gumusalan, Y., Ekerbicer, H.C. et al. Effectiveness of electro-acupuncture compared to sedo-analgesics in relieving pain during shockwave lithotripsy. Urol Res 33, 285–290 (2005). https://doi.org/10.1007/s00240-005-0473-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00240-005-0473-7