Comparison of three analgesic drug regimens with twelfth subcostal nerve block for pain control during extracorporeal shock wave lithotripsy

The use of a virtual reality device (HypnoVR®) during extracorporeal shockwave lithotripsy for urinary stones: A case-control study

INTRODUCTION

Extracorporeal shockwave lithotripsy (SWL) is a standard of care for the management of urinary stones up to 2cm. Although it is generally well-tolerated, ESWL can be a painful procedure for some patients. Virtual reality devices (VRDs) have recently proven to be useful in reducing patient-reported pain during SWL. This study aims to evaluate the safety and efficacy of a VRD during SWL in a case-control study.

MATERIALS AND METHODS

We retrospectively analyzed data of patients undergoing SWL at a single academic stone center. According to patient preference and device availability, a number of procedures were performed using a VRD (HypnoVR®, Strasbourg, France). Patients who underwent more than one SWL session, with at least one session using a VRD, were enrolled in a case-control study (group 1: SWL with VRD, and group 2: SWL without VRD). Periprocedural data were collected. A Visual Analogue Scale (VAS) was used to measure pain tolerance. Descriptive statistics, Chi2 test and t-test were used to compare the 2 cohorts.

RESULTS

A total of 103 procedures with VRD were performed, and 69 procedures were included in the control group. No significant differences in terms of sex, age, BMI, and comorbidities were found between the two groups. In group 1, the median (IQR) stone volume was 109 (78-189) mm3 with a median (IQR) density of 1100 (900-1400) HU, and the stone was located in the kidney in 56 (54%) patients. In the control group, the median (IQR) stone volume was 164 (104-245) mm3, the median (IQR) density was 1195 (918-1356), and stones located in the kidney in 42 (61%) patients. The median (IQR) number of shockwaves was 2831 (2377-3004) in the VRD group versus 2622 (2287-3001) in the control group. The median (IQR) VAS score was comparable between the 2 cohorts: 5 (3-6) in group 1 and 5 (2-5) in group 2. No VRD-related side effects or interruptions have been reported.

CONCLUSION

This study confirms that the use of VRD during SWL is safe, feasible and well-tolerated. However, current results do not demonstrate a reduction in pain during the procedure compared to a control group. VRD may be proposed to patients undergoing SWL.

LEVEL OF EVIDENCE: 3

Effect of acupressure on pain intensity and physiological indices in patients undergoing extracorporeal shock wave lithotripsy: a randomized double-blind sham-controlled clinical trial

BACKGROUND

Despite the widespread use of extracorporeal shock wave lithotripsy (ESWL) as a treatment for kidney stones, it is essential to apply methods to control pain and improve patient comfort during this procedure. Therefore, this study aimed to investigate the effect of acupressure at the Qiu point on pain intensity and physiological indices in patients undergoing ESWL.

METHODS

This randomized, sham-controlled clinical trial was conducted at the Shahid Beheshti Educational-medical Center in Hamadan City (western Iran) from May to August 2023. Seventy-four eligible patients were split into intervention (n = 37) and sham (n = 37) groups. Ten minutes before lithotripsy, the intervention group received acupressure at the Qiu point, while the sham group received touch at a neutral point. The primary outcomes were pain intensity measured by the Visual Analog Scale (VAS) and physiological indices such as blood pressure and heart rate at baseline, 1, 10, 20, 30, 40, and 50 min after the intervention. The secondary outcomes included lithotripsy success and satisfaction with acupressure application.

RESULTS

The analysis of 70 patients showed no significant differences in the demographic and clinical information of the patients across the two groups before the study (P > 0.05). Generalized estimating equations revealed that the interaction effects of time and group in pain and heart rate were significant at 30 and 40 min (P < 0.05). The results of this analysis for systolic blood pressure revealed a significant interaction at 30 min (P = 0.035). However, no significant interaction effects were found for diastolic blood pressure changes (P > 0.05).

CONCLUSIONS

Acupressure at the Qiu point positively impacts pain in patients undergoing ESWL treatment and increases their satisfaction. However, these results for physiological indices require further studies. Thus, acupressure can be considered a simple, easy, and effective option for pain management in patients during this procedure.

TRIAL REGISTRATION

[ https://en.irct.ir/trial/69117 ], identifier [IRCT20190524043687N4].

The Use of a Virtual Reality Device (HypnoVR) During Extracorporeal Shockwave Lithotripsy for Treatment of Urinary Stones: Initial Results of a Clinical Protocol

OBJECTIVE

To assess the impact of a Virtual Reality Device (VRD, HypnoVR, Strasbourg, France) on patient-reported pain and anxiety during extracorporeal shockwave lithotripsy (ESWL).

MATERIALS AND METHODS

We enrolled 30 patients submitted to ESWL for urinary stones. Patients with either epilepsy or migraine were excluded. ESWL procedures were performed using the same lithotripter (Lithoskop; Siemens, AG Healthcare, Munich, Germany) at a frequency of 1 Hz delivering 3000 shock waves per procedure. The VRD was installed and started 10 minutes before the procedure. Tolerability of pain and treatment-related anxiety represented the primary efficacy outcomes and were evaluated using: (1) a visual analogue scale (VAS), (2) the short version of the McGill pain questionnaire (MPQ), and (3) the short version of the surgical fear questionnaire (SFQ). Secondary outcomes were VRD ease of use and patient satisfaction.

RESULTS

Median (IQR) age was 57 (51-60) years and body mass index (BMI) was 23 (22-27) kg/m². Median (IQR) stone size was 7 (6-12) mm with a median (IQR) density of 870 (800-1100) HU. Stone location was kidney in 22 (73%), and ureter in 8 (27%) patients. Median (IQR) extra time for installation was 6.5 (4-8) minutes. Overall, 20 (67%) patients were at their first ESWL treatment. Side effects were experienced by only 1 patient. Comprehensively, 28 (93%) patients would recommend and would use VRD again during ESWL.

CONCLUSION

VRD application during ESWL is safe and feasible. The initial report from patients is positive in terms of pain and anxiety tolerance. Further comparative studies are needed.