Comparison of the analgesic effects of multimodal approach and fentanyl alone during shock wave lithotripsy

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Non Wongvittavas


Background : So far, there has been no consensus on pain control during extracorporeal shock wave lithotripsy (ESWL).

Objective : To compare the analgesic effects of etoricoxib plus fentanyl with placebo plus fentanyl during ESWL in a prospective, randomized clinical trial.

Methods : Ninety-four patients were randomized into two groups: group A (n = 48) received etoricoxib 90 mg orally 1 hour and fentanyl 50 μg intravenously 15 minutes before procedure; group B (n = 46), placebo drug were
given orally 1 hour and fentanyl 50 μg intravenously 15 minutes before procedure. Pain assessment was done with the 10-score linear visual analogue pain scale (VAS) before procedure (0 minute) and then every 15 minutes (15, 30 and 45 minutes) until the procedure was finished. The adverse effects were recorded immediately postoperative periods and at 24-hr postoperative periods.

Results : Mean difference of VAS between group A and B at 0, 15, 30 and 45 minutes were -0.14 (P = 0.530), 0.36 (P = 0.453), -0.15 (P = 0.793) and -0.12 (P = 0.822), respectively. The differences were not statistically significant. In group A, one patient (2%) had urticaria and another (2%) had petechiae at immediate post-operative, and another (2%) at 24-hr postoperative periods.

Conclusion : Our study shows that the analgesic efficacy of multimodal approach by etoricoxib and fentanyl is insignificantly different from that of placebo and fentanyl.

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