Local anaesthetic infiltration with lidocaine versus narcotics in extracorporeal shock wave lithotripsy

During the Previous years ESWL has become a standard procedure for treatmentof patients with renal and ureteric stones. Large element of the pain experienced during ESWL was from the skin surface, the remaining part from deeply situated visceral and musculoskeletal structures. The aim of this study was to investigate if the application of local infiltration anaesthesia to the skin area exposed to the shock wave could obviate the need for intravenous narcotics in ESWL or not. Patients and methods: A randomized double blinded study was done including a total of 50 patients with upper urinary tract stones who would need two sessions of ESWL (either with bilateral stones or had stone (or stones) that need second session). One of the sessions would be done under local anaesthetic infiltration (lidocaine 1%) session L and the other would be done with (saline) placebo session S in the same patient, so personal factor and difference in pain threshold between (patients were excluded. All patients were assessed during the session of ESWL as regard tolerability to ESWL, pain score, need for additionali.v. narcotics, PONV and experience with the procedure. Results: There weresignificant differences between both sessions as regard pain score, the need for iv narcotics, and PONV, being more in sessions S (placebo session). As regard experience with the procedure, it was more pleasant in session L (lidocaine session). Conclusion: We could conclude that local infiltration with lidocaine 1% could obviate the need for i.v narcotics or even decrease the dose needed and make the procedure shorter and better tolerated.