Turkish Journal of Urology
GENERAL UROLOGY - Systematic Review

Local anesthetics versus systemic analgesics for reducing pain during Extracorporeal Shock Wave Lithotripsy (ESWL): A systematic review and meta-analysis


Department of Urology, Universitas Airlangga Faculty of Medicine, Dr. Soetomo General- Academic Hospital, Jawa Timur, Indonesia


Department of Urology, Universitas Airlangga Faculty of Medicine, Universitas Airlangga Teaching Hospital, Jawa Timur, Indonesia


Department of Urology, Universitas Airlangga, Surabaya, Indonesia

Turk J Urol 2021; 47: 270-278
DOI: 10.5152/tju.2021.21143
Read: 256 Downloads: 113 Published: 01 July 2021

Extracorporeal Shock Wave Lithotripsy (ESWL) is one of the treatment options for patients with renal and ureteral calculi. Even though the procedure is less invasive compared to others, pain caused by the procedure is a major concern. Several studies recommended the use of either local or systemic analgesia with varying results. We aimed to compare the use of local anesthetics and systemic analgesics from randomized controlled trials evaluating pain management during ESWL. A systematic search adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol was performed in theMedline, ScienceDirect, and Cochrane library databases. The bias was evaluated using the Cochrane risk of bias tool. Mean difference (MD) was used to analyze continuous outcomes. A total of seven studies were obtained. The topical anesthesia used was eutectic mixture of local anesthetic cream and xylocaine gel. In contrast, the local injection anesthesia used was subcutaneous prilocaine and intracutaneous sterile water injection. The systemic analgesics used were intramuscular and oral forms of sodium diclofenac. There is no significant difference between the visual analogue scale results between the local and systemic groups (P> .05). The differences in ESWL frequency were also insignificant (P > .05). Additional analgesics supplementation (MD 8.44, 95% CI 2.28-14.61, P¼ .007) and the duration of the procedure (MD 1.39, 95% CI 0.21-2.56, P¼ .02) were significantly lower in the local group. Local anesthesia in ESWL shows a similar degree of pain and frequency but has a shorter duration and fewer analgesics supplementation than systemic analgesics.

Cite this article as: Laksita TB, Soebadi MA, Wirjopranoto S, Hidayatullah F, Kloping YP, Rizaldi F. Local anesthetics versus systemic analgesics for reducing pain during extracorporeal shock wave lithotripsy (ESWL): A systematic review and meta-analysis. Turk J Urol. 2021;47(4):270-278.

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