体外冲击波碎石术中不同镇痛药物使用方案比较：随机对照试验
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Comparison of Different Analgesia Drug Regimens for Pain Control During Extracorporeal Shock Wave Lithotripsy for Renal Stones: A Randomized Control Study
背景与目的
随着体外冲击波碎石术（ESWL）的使用增加，尿石症的管理对于患者和医疗卫生服务专业人员而言变得非常简便。然而，术后对疼痛的抱怨十分常见。目前尚未就此情况制定一致的疼痛管理策略。我们比较了不同镇痛药物使用方案对疼痛控制的影响。
方 法
本试验为2015年7月至2016年1月，在世华国际医院进行的一项随机对照试验。共有135名患者被分为三组; A组在手术前30分钟在腰部相应区域局部使用30g 2％利多卡因凝胶，B组在手术前45分钟口服萘普生钠550mg，C组口服萘普生和使用利多卡因凝胶。在手术期间患者补充静脉注射纳布啡。用0-10视觉模拟评分评估疼痛。记录术前和术后疼痛评分。
结 果
本研究共纳入135例患者，男性105例（77.8％），女性29例（21.5％），平均年龄38.7±1.31岁。 B组和C组之间的平均疼痛评分或补充静脉注射纳布啡的需求没有差异，但与A组相比，B组和C组的平均疼痛评分明显降低，需要补充静脉注射纳布啡。
结 论
在ESWL期间与单独使用利多卡因凝胶相比，口服萘普生钠或使用利多卡因凝胶并口服萘普生钠能显著改善疼痛，这是一种有前景的治疗ESWL术中疼痛和控制术后疼痛的方法。
原始文献摘要
Waqas M, Butt A, Ayaz khan M, et al；Comparison of Different Analgesia Drug Regimens for Pain Control During Extracorporeal Shock Wave Lithotripsy for Renal Stones: A Randomized Control Study.；Cureus (April 26, 2017)9(4): e1195. DOI 10.7759/cureus.1195
Introduction
With the increased use of extracorporeal shock wave lithotripsy (ESWL), the management of urolithiasis has become much convenient for the patients and the health care professionals alike. However, associated with the procedure is the common complaint of pain. No agreed upon pain management strategy has yet been developed for the procedure. We compared the effect of different analgesia drug regiments for pain control.
Methodology
A randomised controlled trial was carried out in Shifa International Hospital from between July 2015 to January 2016. A total of 135 patients were divided into three groups; group A received
30 g lidocaine 2% gel applied locally on corresponding lumber area 30 minutes before the procedure, group B received oral naproxen sodium 550 mg 45 minutes before the procedure,
and group C received both oral naproxen and lidocaine gel. Patients were supplemented with intravenous nalbuphine during the procedure. The pain was assessed with 0-10 visual analogue
scale. Both pre-procedure and post-procedure pain score was measured.
Results
Among 135 patients, 105 (77.8%) were male and 29 (21.5%) were female with mean age of 38.7 ±1.31 years. There was no difference of mean pain score or need for supplemental intravenous
nalbuphine between groups B and C but there was significantly decreased mean pain score and need for supplemental intravenous nalbuphine in groups B and C in comparison with group A.
Conclusion
The use of oral naproxen sodium with or without the addition of lidocaine gel during ESWL is a promising option for pain management during the procedure with significant improvement in
comparison with lidocaine gel alone.
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