Comparison of Three Analgesic Treatment Protocols for Pain Management during Extracorporeal Shock Wave Lithotripsy

Introduction: In this prospective and randomized study, we aimed to compare the efficacy of a eutectic mixture of local anesthetics (EMLA) cream, diclofenac sodium (DS) and EMLA in combination with DS (EMLA+DS) for pain management during extracorporeal shock wave lithotripsy (ESWL). Patients and Methods: 120 patients who had undergone ESWL for renal stones were included in the study. The patients were randomized into three groups: the first group was treated with a eutectic mixture of local anesthetics cream (EMLA), while intramuscular DS was applied to the second group and EMLA+DS was applied to the third group. Pain during ESWL was assessed with the 10-score linear and visual analogue pain scale and was compared between groups. Results: Mean age was 44.4 ± 1.9 years. There was no statistically significant difference between groups regarding patients’ mean age, weight, stone size, shock waves, duration of ESWL and energy level values (p > 0.05). The mean pain score during ESWL was 3.90 ± 0.16 in the EMLA group, 3.28 ± 0.18 in the DS group and 3.05 ± 0.18 in EMLA+DS group (p = 0023). Conclusion: DS appears to be more efficient than EMLA in reducing pain during ESWL. Using EMLA+DS has no superiority in relieving pain compared to DS-only treatment.