RESUMO
Abstract: Treatment of urolithiasis has been revolutionized with the introduction of extracorporeal shock wave lithotripsy [ESWL] due to its simplicity, non-invasive nature, efficacy, and minimal morbidity. Pain experienced during ESWL is considered to be multifactorial including type of lithotripter used, frequency, voltage, age, and sex of patient. Various analgesic agents including opiods, nonsteroidal anti-inflammatory drugs, local anesthetic agents and a number of combinations have been used during extracorporeal shock wave lithotripsy by various techniques
Objective: Compare the mean pain score after giving Diclofenac Sodium versus Nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy. Study Design: Randomized control trial study Setting: Department of Urology SIMS/SHL Lahore Period: 01.12.2012 to 01.05.2013
Methods: Total number of 150 [75in each] patients were included in two groups [Diclofenac sodium group A SD 3.28+ 0.18, Nalbuphine group B SD 4.11 + 1.69]. Inclusion and exclusion criteria strictly followed. Detailed history including [age sex address], informed consent, labs, bleeding profile, RFT, X-rays KUB, USG, IVU, and pregnancy test checked. Patients divided in two groups by lottery method. Injection Diclofenac sodium given deep intramuscular, while Nalbuphine HCL intravenous. Both groups were observed pain during ESWL. Data was analyzed by using SPSS version 10, SD, P value calculated
Results: A total of 150 [75 in each group] cases were enrolled after fulfilling the inclusion/exclusion criteria, majority of the patients in both groups were between 41-50 years i.e. 33.33%[n=25] in Diclofenac sodium group and 32%[n=24] in Nalbuphine group, mean and SD was calculated as 35.98+3.54 in Diclofenac sodium and 37.32+3.83 years in Nalbuphine group, 58.67%[n=44] in Diclofenac sodium and 52%[n=39] in Nalbuphine group were male while 41.33%[n=31] in Diclofenac sodium and 48%[n=36] in Nalbuphine group were females, mean pain score after giving diclofenac sodium versus nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy was recorded as 3.09+0.54 in Diclofenac sodium and 4.93+0.79 in Nalbuphine Group, p value was computed as 0.05
Conclusion: We concluded that on comparison of mean pain score after giving Diclofenac Sodium versus Nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy, significant low pain score was recorded in patients treated with Diclofenac Sodium which may be used in future to control the pain
RESUMO
A 3 years old boy was admitted with complaints of pain abdomen and progressive abdominal distension for 04 months. Initially he had severe vomiting and diffuse abdominal pain. Vomiting settled in 4-5 days but dull pain persisted in whole abdomen, which later localized to the upper abdomen. For the last one month frequency of pain and abdominal distension increased. On examination he was pale, sick looking, febrile and weighed 13 kg. Abdomen was distended, especially a bulge was noted in left upper quadrant. There was moderate tenderness present all over the abdomen. Ultrasonography [USG] abdomen revealed a large cystic mass adjacent to left kidney extending posteriorly. Findings were consistent with large size left perinephric abscess. Other investigations revealed hemoglobin [Hb] 9.0 gm%, total leukocyte count [TLC] 15,800/mm, ESR 85 mm and serum urea 27 mg/dl. Based on these findings, US- guided aspiration was planned. Suddenly condition of child deteriorated. He became cyanosed with cold, clammy extremities and developed moderate difficulty in breathing. He was immediately shifted to intensive care unit when i/v fluids, oxygen inhalation and fresh whole blood was transfused. USG abdomen was repeated. It revealed massive ascites while size of cystic mass had reduced to about 20% of the size noted previously. Diagnostic aspiration of ascitic fluid was done. Fluid was hemorrhagic amylase level 15000 u/l. Repeat blood tests showed Hb 6.5 gm%, TLC 36.6x109/l, serum urea 7.1 mmol/l. Serum amylase 1800 u/l, blood sugar 6.3 mmol/l and serum calcium 2.2 mg%. Based on these findings, he was diagnosed as a case of pancreatic pseudocyst which ruptured spontaneously leading to shock. Continued