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

Extracorporeal shock wave lithotripsy (ESWL) is a new treatment modality for retained common bile duct stones. Sixty-two patients (mean age 75 years, range 27-95 years) with retained common bile duct stones were treated with two different lithotriptors. One of the lithotriptors operated on the electrohydraulic principle (Dornier HM-3) (n = 13), the other on the electromagnetic principle (Siemens Lithostar) (n = 49). All HM-3 patients were treated under general anaesthesia, whereas with the Lithostar one patients was treated under general anaesthesia, 43 received analgesia and sedation and five had no analgesia at all. Patients treated with the Lithostar had more sessions (mean 1.9 versus 1.3, P less than 0.05) and needed more stock waves (mean 8611 versus 2534, P less than 0.001) than patients treated with the HM-3. Fragmentation was achieved in all patients treated with the HM-3 and in 42 (86 per cent) patients treated with the Lithostar. In this latter group ten patients underwent common bile duct exploration without complications. Eleven patients had transient haematuria after treatment with the HM-3 and two patients (one in each group) had a subcapsular haematoma of the right kidney, all without clinical sequelae. At follow-up (median: HM-3 43 months, Lithostar 18 months), none of the patients had biliary complaints. We conclude that ESWL of retained common bile duct stones in safe and effective with both lithotriptors and should be considered before surgery in the elderly or high-risk patient.
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PMID:Extracorporeal shock wave treatment of common bile duct stones: experience with two different lithotriptors at a single institution. 187 7

Fifty-three unpremedicated outpatients undergoing elective extracorporeal shock wave lithotripsy using an unmodified Dornier HM-3 lithotriptor received one of two different intravenous sedation-analgesia techniques. Both intravenous midazolam-alfentanil and fentanyl-propofol techniques produced conditions comparable to those achieved with epidural anesthesia during immersion lithotripsy. Of the two sedative-analgesic techniques, midazolam-alfentanil was associated with greater intraoperative amnesia (81% vs 38%), whereas fentanyl-propofol produced less cardiorespiratory depression and fewer postoperative side effects (e.g., pruritus). Compared with a standard epidural anesthesia technique, the mean anesthesia and recovery times were significantly shorter with the two intravenous sedation-analgesia techniques (57-62 min vs 105 min and 143-147 min vs 199 min, respectively). These data suggest that combinations of either midazolam and alfentanil or fentanyl and propofol are viable alternatives to epidural anesthesia for outpatient immersion lithotripsy.
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PMID:Comparison of intravenous sedative-analgesic techniques for outpatient immersion lithotripsy. 201 18

Sixty unpremedicated outpatients undergoing elective extracorporeal shock wave lithotripsy using an unmodified Dornier HM-3 lithotriptor were randomly assigned to receive an intravenous infusion of either alfentanil or ketamine as an adjuvant to midazolam for sedation and analgesia. Although both drug regimens allowed the maximal number of shock waves and energy level, the alfentanil group had significantly better calculi fragmentation (78% vs. 50% of patients with fragments less than 2 mm). Ketamine infusion provided superior intraoperative cardiorespiratory stability; however, it was associated with more disruptive movements (22 vs. 5) and dreaming (35% vs. 5%) during the procedure (P less than 0.05). Postoperatively, confusion also occurred more frequently in the ketamine-treated patients (31% vs. 5%, P less than 0.05). Alfentanil infusion was associated with more episodes of hemoglobin oxygen desaturation to less than 90% (12 vs. 2, P less than 0.05), itching (23% vs. 4%, P less than 0.05), and ability to recall intraoperative events (45% vs. 12%, P less than 0.05). The incidence of postoperative nausea was decreased (not significantly) in the alfentanil group (32% vs. 54%). The mean anesthesia time was similar in both groups; however, discharge times (means +/- standard deviations) were shorter in the alfentanil group (142 +/- 42 min vs. 161 +/- 31 min, P = 0.05). These data suggest that although both techniques proved effective for anesthesia in outpatients undergoing immersion lithotripsy, alfentanil is superior to ketamine as part of a sedative-analgesic technique because of the improved recovery profile and calculi fragmentation.
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PMID:Comparison of alfentanil and ketamine infusions in combination with midazolam for outpatient lithotripsy. 204 57

In June 1988, the new type of the lithotripter MPL 9000 (Dornier), which was the first interdisciplinary lithotripter for treatment of urinary and biliary calculi, was installed at the Shakai Hoken Chukyo Hospital. MPL 9000 has some features which enable one to treat with low range of shock wave energy and without anesthesia due to the enlarged aperture of the ellipsoid (210 mm), and locate the stone by computerized two ultrasound probes (coaxial, lateral). Unlike HM-3, the water bath is not used: shock wave is shot through the water cushion. From June to November 1988, 35 patients suffering from 64 urinary calculi were treated. The majority represented caliceal (75%) and pelvic (17%) stones, whereas 5 calculi were treated in the upper and lower ureter. Twenty-four patients were treated in one session and 11 patients needed additional sessions. The given number of shock waves was between 1337 and 3050 per one session and averaged 2403 with low generator voltage (15-18 kv). Twenty sessions (42%) were given without any medication and other 28 sessions (58%) were under analgesia (Pentazocine, i.v.) for the pain complained during the treatment. The rate of successful disintegration (less than 5 mm) was 88%. After the 1-month followup, 47.1% were free of stone, and 62.1% were free after the 3-month. Four patients had arrhythmia and one patient was with a subcapsular renal hematoma. We have concluded that this lithotripter is useful to treat upper and lower urinary tract calculi, in particular radiolucent ones in high risk patients because it is applicable without anesthesia.
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PMID:[Clinical experience with ESWL with new Dornier lithotripter MPL 9000]. 232 21

We sought to determine whether topically applied eutectic mixture of local anesthetics (EMLA) would decrease analgesic requirement during extracorporeal shock wave lithotripsy (ESWL). Fifty-nine healthy out-patients undergoing elective ESWL using an unmodified Dornier HM-3 lithotriptor were randomly assigned to receive either a topical EMLA or placebo cream applied to the skin of the flank overlying the kidney 90 min prior to the ESWL procedure. Patients were given five test shocks at each of five different energy levels: 10, 12, 15, 18, and 20 kV. Patients evaluated the average pain at each stimulus level using a visual analog scale. Overall pain scores were significantly lower in EMLA-treated patients at 18 and 20 kV (P < 0.05). EMLA cream was significantly more effective at decreasing cutaneous pain in male than in female patients. However, during the lithotripsy procedure, EMLA cream had no significant effect on the intraoperative requirement for intravenous alfentanil, hemodynamic variables, recovery times, or postoperative side effects. Although the topical application of EMLA cream produced cutaneous analgesia, these data suggest that it failed to produce any opioid-sparing effect during the immersion lithotripsy procedure.
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PMID:Effect of topical eutectic mixture of local anesthetics on pain response and analgesic requirement during lithotripsy procedures. 772 10