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

Study Objective: To evaluate the opioid-sparing and analgesic effect o f diclofenac sodium in ambulatory nonimmersion extracorporeal shock wa ve lithotripsy (ESWL). Design: Randomized, double-blind, placebo-contr olled study. Setting: Large referral hospital. Patients: Twenty-seven ASA physical status I and II patients with upper renal tract nephrolit hiasis. Interventions: ESWL was performed with a sedative-analgesic te chnique. Diclofenac sodium 75 mg or an equal volume of saline was give n intramuscularly 45 minutes prior to the procedure. Fentanyl and mida zolam were added to maintain adequate sedation and analgesia. Measurem ents and Main Results: Demographically, both groups were comparable. I n the diclofenac sodium group, heart rate was slightly higher, treatme nt time was shorter, more shock waves were administered (p < 0.02), an d less fentanyl was required (p < 0.02). Mean arterial pressure was lo wer 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 nonimmersi on ESWL.