buprenorphine and Kidney-Calculi

The effectiveness of a balanced analgesia with buprenorphine ketoprofen-propacetamol for pain control during extracorporeal shock wave lithotripsy (ESWL) was evaluated in order to reduce the requirements for general anaesthesia. Two hundred and ninety-one consecutive patients were included in a randomized, placebo-controlled, double-blind study. Patients in each group received midazolam 5 mg pre-operatively as premedication. The subjects then received either placebo (group 1), buprenorphine 0.3 mg (group 2) or the combination buprenorphine 0.3 mg plus ketoprofen 100 mg and propacetamol 2 g (group 3) intravenously (i.v.) at a constant rate. The treatment was started 45 min prior to ESWL. Pain was assessed using a three-point verbal scale: (0)no pain; (1) moderate pain; and (2) intense pain needing general anaesthesia. The patients assessed their pain intensity on a 0-100 mm visual analogue scale. Only 69% of group 1 patients received ESWL with midazolam premedication. Buprenorphine provided good analgesia in 87% of group 2 patients, while the combination buprenorphine-ketoprofen-propacetamol was effective in 99% of group 3 patients (P < 0.05). The incidence of nausea and vomiting was similar in the buprenorphine groups. No respiratory depression was reported. In conclusion, the buprenorphine-ketoprofen-propacetamol combination provided effective analgesia, allowing ESWL to be performed without the need for general anaesthesia.

Topics: Acetaminophen; Adolescent; Adult; Aged; Aged, 80 and over; Analgesics, Non-Narcotic; Analgesics, Opioid; Anesthesia, General; Buprenorphine; Double-Blind Method; Female; Humans; Ketoprofen; Kidney Calculi; Lithotripsy; Male; Middle Aged; Pain; Pain Measurement; Premedication

The efficacy of sublingual buprenorphine given for premedication was assessed in 287 consecutive patients scheduled for extracorporeal shock wave lithotripsy (ESWL). The patients were randomly assigned to three groups. They were given 45 min before starting ESWL 5 mg midazolam orally in group 1 (n = 97), and 5 mg midazolam orally and 0.2 mg sublingual buprenorphine in group 2 (n = 97), and 5 mg midazolam orally and 0.4 mg sublingual buprenorphine in group 3 (n = 93). Analgesia was assessed with a simple three step verbal scale: no pain, moderate pain treated with simple analgesics (Spasfon, Viscéralgine), and exquisite pain requiring general anaesthesia. Sublingual buprenorphine provided good analgesia in 87% of group 2 patients, and 88% of group 3 patients (NS) whereas 70% of group 1 patients experienced no pain (p < 0.05). The incidence of side-effects during the 12 h following ESWL, such as nausea, vomiting and drowsiness, was higher in group 3 (31 patients) than in group 2 (13 patients) (p > 0.01). No clinical respiratory depression occurred, although 11 patients in group 3 complained of drowsiness. It is concluded that premedication with 0.2 mg of sublingual buprenorphine provides efficient analgesia for ESWL and few side-effects.

Topics: Administration, Sublingual; Adolescent; Adult; Aged; Aged, 80 and over; Analgesia; Buprenorphine; Drug Combinations; Female; Humans; Kidney Calculi; Lithotripsy; Male; Midazolam; Middle Aged; Pain Measurement; Preanesthetic Medication

Topics: Adolescent; Adult; Aged; Analgesics; Buprenorphine; Cholelithiasis; Clinical Trials as Topic; Female; Humans; Indomethacin; Kidney Calculi; Male; Meperidine; Middle Aged; Ureteral Calculi