Analgesia for patients undergoing shockwave lithotripsy for urinary stones – a systematic review and meta-analysis

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Vol. 43 (3): 394-406, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0078


REVIEW ARTICLE

Omar M Aboumarzouk 1, Rami Hasan 2, Ali Tasleem 2, Martin Mariappan 2, Rachael Hutton 3, John Fitzpatrick 3, Laura Beatty 3, Gareth E Jones 2, Tarik Amer 2
1 North Bristol NHS Trust, United Kingdom; 2 NHS Greater Glasgow and Clyde, United Kingdom; 3 Ayr University Hospital, United Kingdom

ABSTRACT

Background: Shock wave lithotripsy (SWL) is the first line treatment modality for a significant proportion of patients with upper urinary tracts stones. Simple analgesics, opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are all suitable agents but the relative efficacy and tolerability of these agents is uncertain.

Objectives: To determine the efficacy of the different types of analgesics used for the control of pain during SWL for urinary stones.

Materials and Methods: We searched the Cochrane Renal Group’s Specialised Register, MEDLINE, EMBASE and also hand-searched reference lists of relevant articles (Fig­ure-1). Randomised controlled trials (RCT’s) comparing the use of any opioid, simple analgesic or NSAID during SWL were included. These were compared with themselves, each-other or placebo. We included any route or form of administration (bolus, PCA). We excluded agents that were used for their sedative qualities. Data were extracted and assessed for quality independently by three reviewers. Meta-analyses have been performed where possible. When not possible, descriptive analyses of variables were performed. Dichotomous outcomes are reported as relative risk (RR) and measurements on continuous scales are reported as weighted mean differences (WMD) with 95% confidence intervals.

Keywords: Calculi; Lithotripsy; Urinary Tract

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