CUTANEOUS ANAESTHESIA IN ESWL PRESENTED BY SRMC & RI Dr.GOVINDARAJAN. Dr.ABRHAM KURIEN. Dr.SANJAY PANDEY. Dr. R.P.RAJAN. Dr.SANKARAN.

PAIN IN ESWL PAIN DURING THE PROCEDURE OF ESWL ARISES FORM THE SKIN / SOFT TISSUES AND AT FOCAL POINT OF THE SHOCK WAVE PATH. THIS PAIN NEEDS ALEVIATION FOR A SUCESSFUL PROCEDURE. DEGREE OF PAIN PERCEIVED HAS INDIVIDUAL VARIATIONS. PAIN RELIEF MEASURES ARE TO BE INDIVIDUALISED FOR OPTIMAL BENEFIT.

VARIOUS PAIN RELIEF OPTIONS NSAIDS PARENTAL SEDATIVES : FORTWIN ALFENTANIL MIDAZOLAM PROPOFOL TROPICAL AGENTS PRILOCAINE & LIDOCAINE cream.

DISADV.OF SEDATIVES SEDATIVE EFFECT LONG AFTER THE PROCEDURE IS OVER – NEED FOR A LONGER DURATION OF HOSPITAL STAY. INHERENT ADVERSE EFFECT OF THE DRUG WITH LOW EFFICASY WHEN USED ALONE(PARTICULARLY NSAIDS).

CUTANEOUS ANAESTHETIC AGENT OUR PROSPECTIVE STUDY USED PRILOCAINE WITH LIDNOCVAINE A EUTACTIC MIXTURE. THIS IN THE FORM OF A CREAM WAS APPLIED LOCALLY 40 MTS BEFORE THE PROCEDURE. IF NEEDED INTAVENOUS SEDATION IS ADMINISTED DURING THE PROCEDURE.

STUDY MATERIALS PATIENTS UNDER GOING ESWL FOR BOTH RENAL AND URETERIC CALCULI AT SRMC & RI WERE INCLUDED IN THE STUDY ON RANDOM BASIS. A TOTAL OF 26 PATIENTS WERE OBSERVED.

PAIN ASSESMENT ASSESMENT OF PAIN WAS BASED ON THE PAIN CHART WHICH HAS PROVISION FOR BOTH THE DOCTER AND THE PATIENT TO GRADE PAIN AND MEAN OF THE TWO WAS FINAL PAIN LEVEL THIS PICTORIAL CHART IS ACCEPTED TO BE SUPERIOR THAN QUESTIONNAIRE ASSESMENT.

RESULTS IN 18 PATIENTS THIS WAS SUFFICAINT PRIMARY PAIN CARE(two of them experienced mild bearable pain). IN 6 PATIENTS SEDATIVE WAS NEEDED AS ADJUVANT (INJ.FORTWIN UPTO 10 mg) USED. TWO OF THE PATIENTS REQUIRED SEDATIVE MORE THAN 10 mg(30mg ).

EFFICASY OF L.A. 7 PATIENTS TOLERATED WITHOUT SUBJECTIVE/OBSERVER IDENTIFICATION OF PAIN( UP TO INTENCITY 4).(PAIN SCORE – I) 9 PATIENTS THOUGH HAD MILD PAIN DID NOT NEED ANY ADJUNCTIVE MEASURES.(PAIN SCORE II). 2 PATIENTS EXPERIENCED MODERATE PAIN BUT STILL DID NOT REQUIRE INTERVENTION.(PAIN SCORE – III).

EFFICASY…CONT. 6 OF OUR PATIENTS REQUIRED IV SEDATION-YOUNG AGE, HYPERDENSE STONE, PROLONGED PROCEDURE.(PAIN SCORE III). TWO OF OUR PATIENTS WERE ANXIOUS AND REQUIRED IV SEDATION AT THE BEGINNING OF THE PROCEDURE (PAIN SCORE IV).

PAIN SCORE

CONCLUSION LOCAL ANEASTHETIC APPLICATION ALONE IS SUFFICIENT PAIN CARE. IF SEDATION IS USED THEN THE DOSE OF ITS ADMINISTRATION IS REDUCED. NO UNTOWAD SIDE EFFECTS NOTED. SIMPLE AND COMFORTABLE.

CONCLUSIONS RENAL MOVEMENT WITH RESPIRATION IS OBVIOUS IN SOME CASES. ANXIOUS PATIENTS MIGHT NOT BE COMFORTABLE DURING THE PROCEDURE. CALCULI RESISTANT TO FRAGMENTATION MAY NEED ADDED IV SEDATION (CYSTINE,WHELLELITE,BRUSHITE). THIN INDIVIDUALS HAVE MORE PAIN BECAUSE OF MORE CONVERGENCE