THE OPIOID-SPARING EFFECT OF DICLOFENAC SODIUM IN OUTPATIENT EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY (ESWL)

Study Objective: To evaluate the opioid-sparing and analgesic effect of diclofenac sodium in ambulatory nonimmersion extracorporeal shock wave lithotripsy (ESWL). Design: Randomized, double-blind, placebo-controlled study. Setting: Large referral hospital. Patients: Twenty-seven ASA physical status I and II patients with upper renal tract nephrolithiasis. Interventions: ESWL was performed with a sedative-analgesic technique. Diclofenac sodium 75 mg or an equal volume of saline was given intramuscularly 45 minutes prior to the procedure. Fentanyl and midazolam were added to maintain adequate sedation and analgesia. Measurements and Main Results: Demographically, both groups were comparable. In the diclofenac sodium group, heart rate was slightly higher, treatment time was shorter, more shock waves were administered (p < 0.02), and less fentanyl was required (p < 0.02). Mean arterial pressure was lower and arterial oxygen saturation by pulse oximeter was higher in the diclofenac sodium group. There were no differences between the groups in voltage, stone size, fragmentation, dose of midazolam administered, or overall assessment by both the doctors and patients. Conclusions: Patients administered diclofenac sodium received a greater number of shock waves, required less fentanyl, and showed a marginal improvement in hemodynamic stability and oxygenation during ambulatory nonimmersion ESWL.