Effectiveness of eutectic mixture of local anesthetic cream and occlusive dressing with low dosage of fentanyl for pain control during shockwave lithotripsy

Abstract

Background and Purpose: To investigate the effect and usefulness of Eutectic Mixture of Local Anesthetic (EMLA) applied with an occlusive dressing and used simultaneously with a low dose of fentanyl during shockwave lithotripsy (SWL). Patients and Methods: One hundred sixty patients with kidney stones, aged between 19 and 68 years, were randomly, divided into seven groups that were treated as follows: group 1: fentanyl 1 mu g/kg by intravenous infusion (IV); group 2: IV fentanyl 0.25 mu g/kg; group 3: occlusive dressing and IV fentanyl 0.25 mu g/kg; group 4: placebo cream and IV fentanyl 0.25 mu g/kg; group 5: EMLA cream and IV fentanyl 0.25 mu g/kg; group 6: placebo cream and IV fentanyl 0.25 mu g/kg with an occlusive dressing; and group 7: EMLA cream and IV fentanyl 0.25 mu g/kg with an occlusive dressing. The mean arterial pressure (MAP), heart rate, ventilatory rate, and oxygen saturation (SpO(2)) were recorded on all patients. A visual analog scale 0-100 mm (VAS) was used for the evaluation of pain. The skin integrity was inspected to detect any lesions after SWL. Results: The SPO2 in group I was lower statistically than in the other groups. The VAS score in group 7 was clearly lower than in the others in the first, tenth, and twentieth minutes and at the end of SWL. In groups 6 and 7, additional fentanyl doses were lower than in the other groups, but only in group 7 was the total fentanyl dosage low. Skin lesions were not seen only in groups 3, 6, and 7. Conclusion: Use of EMLA and an occlusive dressing with low doses of fentanyl during SWL provides appropriate analgesia with minimal morbidity.