Petroleum jelly is an ideal contact medium for pain reduction and successful treatment with extracorporeal shock wave lithotripsy

Purpose: Various minimally invasive approaches to reduce pain during extrac orporeal shock wave lithotripsy (ESWL*) have been described. We compared pe troleum jelly (Vaseline dagger) and ultrasound gel in vitro as a contact me dium. based on the stone fragmentation rate. The analgesic effect of cutane ous petroleum jelly was tested against eutectic mixture of local anesthesia . We also evaluated the outcome of ESWL in a large group of patients treate d with petroleum jelly. Materials and Methods: In vitro 3 artificial stones were completely fragmen ted with a MFL 5000* lithotriptor using petroleum jelly or ultrasound gel a s a contact medium. A total of 110 patients (group 1) received petroleum. j elly before treatment with the same lithotriptor. After retrospective analy sis of group 1 we matched 32 patients (group 2) receiving cutaneous eutecti c mixture of local anesthesia. Because of the favorable results with petrol eum jelly, we used it in another 148 patients, for a total of 258 patients (group V). Treatment dependent pain was scored using a questionnaire as 1-n o, 2-minor, 3-tolerable and 4-intolerable. ESWL without additional analgesi cs had a pain score of 1 to 3. Results: In vitro petroleum jelly had a superior fragmentation rate compare d to ultrasound gel. Our long-term experience with the lithotriptor indicat ed that only 30% of patients required no additional analgesics with cutaneo us ultrasound gel. In contrast, no additional analgesics were needed in onl y 38% of group 2 compared to 81.8% of group V. The stone fragmentation rate did not differ statistically between groups. Conclusions: Cutaneous petroleum jelly offers a noninvasive, highly effecti ve, inexpensive treatment modality with no side effects and significant red uction in pain. This ointment is our contact medium of choice.