The Efficacy and Safety of Lidocaine 1% by Local Infiltration as a Monotherapy in Extracorporeal Shock Wave Lithotripsy

Background and Aims: Extracorporeal shock wave lithotripsy (ESWL) represents first line therapy for the majority of urinary tract calculi and requires anesthesia. The purpose of this study is to prospectively evaluate the analgesic effects and safety of lidocaine 1% by local infiltration as a monotherapy during renal ESWL and ensure stone clearance after the procedure. Methods: One hundred patients with renal stones, aged 18 to 65 years, were randomly allocated into two groups; 49 patients in group 1 received intramuscular injection of 20 mg Ketorolac tromethamine, 20 minutes before start of the procedure and 51 patients in group 2 received Lidocaine 1% by local infiltration (5mg/kg) into the 30 cm2 area after localizing the stones site, 10 minutes before the session. A visual analog scale, (0 to 100 mm) was used to evaluate pain every 10 minutes.

Results: The visual analog scores for group 2 were significantly lower than (group 1) at 10, 20, 30 and 40 minutes till end of the procedure, (p <0.001). The mean requirements of supplemental fentanyl analgesia (μg) were significantly decreased in group 2 than group 1, (3.34 ± 7.32 versus 15.72 ± 6.41, p<0.001). All patients in group 2 were discharged earlier, 1 hour after the end of the procedure while 13 patients (26.5%) in group 1 had delayed discharge. No significant difference was detected between the two groups with regards to complete stone clearance after 1 month, no. of shocks, voltage power or duration of procedure. No patient in group 2 reported neurological side effects of local anesthesia.

Conclusions: Lidocaine 1% by local infiltration cannot be used alone for pain relief but effectively reduced the analgesic needs and minimized hospital stay after renal ESWL, without affecting stone clearance.