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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between March 1988 and March 1990, 751 patients were treated with shock wave lithotripsy using EDAP LT-01. Six hundred and eight patients had renal stones while 143 patients had stones located in the ureter. Because of difficulties in locating ureteric stones with ultrasound 92% of them were pushed back to the kidney before treatment. The mean stone size was 10 mm, range 4-30 mm. Patients with stones bigger than 15 mm had a double J-stent placed before treatment. The mean number of treatments per patient was 1.7 (range 1-8). Sixty-six per cent of the patients with renal stones were completely stone-free after ESWL monotherapy. Another 5% became stone-free after auxiliary procedures in the ureter, because of retained fragments. Fragments equal to or less than 4 mm were retained in 14% of the patients with the renal stones. Of the patients with ureteric stones mobilised back to the kidney 95% were rendered stone-free after ESWL. Most patients experienced no or very little discomfort during the treatment and only 29% of them received analgesics. General of epidural anaesthesia was given to 1% of the patients. Because of the low demand for analgesia or anaesthesia, 99% of the patients with renal stones were treated on an outpatient basis. During the second year, 74% of the patients with ureteric stones were treated on an outpatient basis.
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PMID:Outpatient-based extracorporeal shock wave lithotripsy using EDAP LT-01. 178 16

Piezoelectric second generation lithotriptors are an established means of administering extracorporeal shockwave lithotripsy (ESWL) enabling treatment to be performed without anaesthesia or analgesia, but higher shockwave doses and multiple or staged treatment are frequently required. The bioeffects of this modality of ESWL, therefore, require further assessment. Seven experimental groups of adult male rabbits were treated using the EDAP LT.01 in order to determine the acute and chronic bioeffects of clinical dose, excess dose, divided excess dose, high frequency and multiple treatment (X10) piezoelectric shockwaves (PSW). Renal function was measured before and after treatment using mercaptoacetyltriglycine (MAG 3) scans. Gross and histological morphological changes were assessed at one and 30 days following application of PSW. Application of single clinical dose PSW was not associated with any significant functional or morphological renal injury. Excess dose PSW caused transient gross renal contusion, which resolved in the majority of animals with no persistent microscopic abnormality. Divided excess dose PSW resulted in no gross or microscopic damage. High frequency PSW was associated with mild histological abnormality. Multiple PSW treatments caused small discrete fibrotic lesions in all cases, without any change in renal function.
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PMID:Acute and chronic bioeffects of single and multiple doses of piezoelectric shockwaves (EDAP LT.01). 182 66

This study evaluates, 1) the pain induced by extracorporeal shock wave lithotripsy for renal stones using a piezo-electric shock wave lithotriptor (EDAP LT 01) and 2) the predictive factors for severe pain leading to an indication for analgesia. The relationship between extracorporeal shock wave lithotripsy intensity and pain intensity is evaluated by a numerical scale at the beginning of the session (T0), after 15 min (T15) and after 30 min (T30). At the end of the session, patients are categorized by one of us using a three-point scale which integrates the pain and the maximum tolerable intensity. These two types of evaluation are well correlated. Successive levels of stimulation are well discriminated by patients. Habituation is observed during the session for patients with low-level pain. In 28% of the patients, the intensity of pain required analgesia. Pain cannot be predicted by age, anxiety state, side of the stones and size, diameter of the contact between patient and convergence dome. In contrast, three parameters are correlated with the pain level: The L1 distance of renal parenchyma and the L2 distance skin-stone crossed by the piezoelectric waves, the size of the stone. The superior caliceal, middle caliceal and pelvic stones are significantly the most painful. These predictive variables can be easily measured before extracorporeal shock wave lithotripsy.
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PMID:[Pain and extracorporeal lithotripsy for calculi of the upper urinary tract]. 186 65

The efficacy of the combination of piezoelectric lithotripsy and oral bile acids in the treatment of gallbladder stones was assessed. Three hundred and sixty-three patients with symptomatic radiolucent gallstones in functioning gallbladder were treated in five medical centers using the same protocol with the EDAP LT 01 lithotripter. No anesthesia, analgesia or sedation was used. After one session of lithotripsy, fragmentation was observed in 89% of the patients, and satisfactory fragmentation (fragments less than or equal to 5 mm) in 29%. The satisfactory fragmentation rate was higher in patients with solitary stones less than or equal to 20 mm than in patients with solitary stones 21-35 mm or multiple stones (p less than 0.001). After multiple sessions (mean 1.6 session/patient, range 1-5) the overall rate of satisfactory fragmentation was 50%. After 12 months on oral bile acid therapy, complete clearance of the gallbladder was observed in 69% of patients with solitary stones less than or equal to 20 mm, 25% of patients with solitary stones 21-35 mm and 37% of patients with multiple stones. No complication was observed during the lithotripsy. During follow-up under bile acid therapy, there were five complications (1.4%): four patients had acute cholecystitis and one had mild, self-limited pancreatitis. We conclude that piezoelectric lithotripsy with the EDAP lithotripter is a safe and effective treatment which can be performed in outpatients. Satisfactory fragmentation and rapid disappearance of stones are obtained mainly in patients with solitary stones less than or equal to 20 mm.
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PMID:Treatment of gallstones with piezoelectric lithotripsy and oral bile acids. A multicenter study. 194 Feb 62

The results of the EDAP International Corporation multicenter trial to test the efficacy and safety of its piezoelectric lithotripter in conjunction with ursodeoxycholic acid therapy for the treatment of gallstones are reported. Three hundred and sixty-two patients with one to three radiolucent calculi in a functioning gallbladder were studied. The mean stone size burden was 19 millimeters and was less than 30 millimeters in all patients. Lithotripsy treatment sessions were performed without analgesia or sedation in 72 per cent of the patients. Post-treatment complications were minimal. There were six patients with pancreatitis; two of whom had obstruction of the common bile duct by stone fragments. Three of these patients required endoscopic papillotomy. At the present time 120 of the patients (33.0 per cent) are stone-free and 197 (54.4 per cent) have residual fragments. Of the 163 patients in the study for at least six months, the stone-free rate is 44 per cent and for those individuals with a solitary stone less than 20 millimeters in size, the stone-free rate is 56 per cent. Biliary lithotripsy using piezoelectric techniques followed by adjuvant ursodeoxycholic acid is effective and is performed without significant pain or morbidity in the majority of patients.
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PMID:The results of the EDAP multicenter trial of biliary lithotripsy in the United States. The EDAP Investigators Group. 194 3

We report the results of extracorporeal piezoelectric lithotripsy of gallbladder stones, using the EDAP LT 01 device, in 60 patients treated without anaesthesia or analgesia. Fragmentation was satisfactory (i.e. with fragments less than 5 mm wide) in 31 patients (52 per cent) after multiple sessions (mean: 1.6). The satisfactory fragmentation rate was higher in patients with stones smaller than 20 mm (63 vs 8 per cent; P less than 0.01) and not different in patients with solitary or multiple stones (53 vs 50 per cent). After bile acid dissolution treatment during 3, 6 and 12 months, the stone-free rates were 23, 41 and 64 per cent respectively, and significantly better at 3 and 6 months in patients with satisfactory fragmentation (42 vs 4 per cent; P less than 0.05, and 71 vs 9 per cent; P less than 0.01). Fourteen patients (23 per cent) reported biliary colic, but only one required cholecystectomy. No severe complication was observed. Piezoelectric lithotripsy is safe, requires short hospitalization and gives interesting results when the stones are less than 20 mm wide.
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PMID:[Treatment of gallbladder lithiasis by piezoelectric extracorporeal lithotripsy]. 213 61

This study was done with the EDAP LT 01 piezoelectric lithotripter. Experimental fragmentation of biliary stones was evaluated in vitro and in vivo after implantation of human stones inside the gallbladder of pigs. Tissue damage was appreciated after application of ESWL to the gallbladder of pigs with firing frequencies from 40 to 1.25 shots per second. 125 patients were treated in our centre since 1987. Duration of the session was about one hour, without any anaesthesia or analgesia. The patients are no more hospitalised. An other session was necessary in case of unsatisfactory fragmentation. All the patients were treated by adjuvant dissolving agents. The results are in course of evaluation. Fragmentation of gallstones is obtained in 80 to 99% of the patients. Side effects are rarely observed and there was no case of acute pancreatitis in this series. With the Dornier machine, a complete stone clearance was obtained in 80% of the patients after one year and 93% after two years but there was a 10% rate of gallstones recurrence after one year of clearance. Place of ESWL for gallstones in the future needs to be carefully assessed.
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PMID:[Is extracorporeal lithotripsy in appendicular lithiasis an alternative to cholecystectomy?]. 235 Jul 10

The EDAP LT.01 is a second generation shockwave lithotripter which employs ultrasound imaging and piezoelectric shockwave generation. We describe the first 12 months of its use in the treatment of urinary calculi by urologists with no previous practical experience of ultrasonography. A total of 406 calculi (359 renal and 47 ureteric) in 317 patients were treated. Analgesia or sedation was not routinely used and 59% of all treatments were performed as outpatient procedures. The clearance rate of renal calculi smaller than 1 cm was 81%, while that of calculi larger than 3 cm was 80% (mean clearance 77.5%). Lithotripsy of ureteric calculi following retrograde manipulation to a renal site resulted in 94.4% clearance compared with 39% for those treated at a ureteric site; 93% of 684 lithotripsy treatments were either painless or caused only mild pain. Our experience with imaging and treating urinary calculi with the EDAP LT.01 lithotripter has been excellent. Patients are treated effectively and inexpensively as out-patients without analgesia or sedation.
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PMID:Extracorporeal shockwave lithotripsy using ultrasonic imaging: urologists' experience. 267 38

Over the period of one year, 356 extracorporeal lithotripsies were performed in 303 patients with the EDAP piezoelectric lithotripter. The success rate, depending on the frequency (1.2 to 40 Hz) was between 75 and 80%. The treatment was repeated for 13 to 22% of the patients and 15% underwent an auxiliary manoeuvre preoperatively. Morbidity remains low with less than 5% of ureteral obstruction. For simple or small calculi (less than 1 cm), the use of low frequencies (1.2 to 5 Hz) is preferred, making it possible to carry out the treatment without anaesthesia and without hospitalization. For complex or bigger calculi, the use of higher frequencies (10-20 Hz), under neuroleptic analgesia, seems to be more efficient with a shorter time of treatment and a lower complication rate.
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PMID:[Piezoelectric extracorporeal lithotripsy. Report of 1-year's experience (350 treatments)]. 340 Oct 1

The results of 134 patients who underwent 150 treatments with the EDAP lithotriptor are reported. The first patients were treated with a frequency of 150 Hz under general anesthesia, with a success rate of 64%. In order to decrease the pain induced by the shocks waves, the frequency was lowered (20 Hz and 10 Hz), so that treatment could be performed under neuroleptic analgesia. The success rate was respectively 84% and 90%. A second treatment was required in 11% of the patients and 9% have undergone auxiliary endoscopic manoeuvres preoperatively. Morbidity was extremely low with only 3% of ureteral obstruction. The gradual reduction of anesthesia constitutes an advance in lowered morbidity and costs; in addition, the possibility to repeat the treatments makes the management of complex lithiasis easier.
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PMID:[Treatment of renal calculi with extracorporeal lithotripsy. Experience of the Urology Service at Rennes. Preliminary report on 134 patients]. 367 84


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