Comparison of intravenous Lornoxicam and fentanyl combined with midazolam on analgesia during extracorporeal shock wave lithotripsy

ABSTRACT

Various sedative and analgesic medications have been used for shockwave lithotripsy [SWL]. This study compare the analgesic and side effects of intravenous lornoxicam with that of intravenous fentanyl, in combination with midazolam in ESWL. One hundred patients were randomly divided into two groups; group A [n = 50] received 16 mg lornoxicam i.v. 30 min before ESWL and group B [n = 50] received 2 microg/kg fentanyl i.v. 3 min before ESWL. All patients received 2 mg midazolam i.v. 3 min before ESWL for intraoperative sedation. Pain intensity was evaluated on a visual analog scale [VAS]. A supplemental analgesia with intravenous fentanyl 25 micro g was given when complained of pain, changed position, or grimaced in response to the shockwaves. The level of sedation was determined using the Observer's Assessment of Alertness/Sedation [OAS/S]. Oxygen supplement through a face mask was given when the SpO[2] fell below 94%. Side effects [nausea, vomiting, dizziness] and the time of discharge from post-anesthesia room [PAR] were recorded. There were no differences between two groups in the demographic data, number of shock waves, duration of ESWL procedure, and fentanyl supplement. The incidence of oxygen supplement was lower in lornoxicam group [5/50] compared with that of fentanyl group [20/50], P < 0.01. The frequency of dizziness was lower in lornoxicam group [3/50] than that in fentanyl group [15/50], P < 0.01. Five patients in fentanyl group complained of nausea, but two did in lornoxicam group. The discharge time from PAR was significantly shorter in lornoxicam group [24.4 +/- 3.23 min] than that in fentanyl group [37.14 +/- 5.82 min], P < 0.01. Intravenous lornoxicam plus midazolam could provide an adequate analgesia as good as fentanyl plus midazolam but with a lower incidence of desaturation, nausea/vomiting and dizziness and could be discharged from PAR earlier. Therefore, we suggest that a single-dose intravenous lornoxicam combined with midazolam is a safe and effective regimen for pain relief in ESWL