Comparison of Pain Score After Giving Diclofenac Sodium Versus Nalbuphine in Patients Undergoing ESWL: Our Experience in SIMS/ SHL

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.