Urology Journal

Abstract

Purpose: To compare the clinical efficacy between locally applied diclofenac diethylamine gel,
EMLA cream and systemically given diclofenac sodium for the pain relief during extracorporeal
shock wave lithotripsy (SWL) using Dornier Delta Compact Lithotripter.
Material and Methods: One hundred five patients with renal stones were randomly divided in to
3 groups. Group A was given intramuscular diclofenac sodium (1 mg/kg), 45 minutes before the
procedure. In group B, 10 gm of eutectic mixture of local anesthetic (EMLA) cream and in group
C, 15 gm of diclofenac diethylamine gel was applied locally 45 minutes before the procedure.
Ten-score linear and visual analogue scale (VAS) was used to assess the severity of pain during
the procedure. Analysis of variance (ANOVA) test was used to compare various parameters and
analyzed statistically.
Results: All the three groups were not statistically different with respect to age, weight, stone
size, number of shock wave delivered and maximum voltage used (P > .05). The mean pain score
in group A was 4.48, in group B was 3.60 and in group C was 3.95, which were not significantly
different (P = 1.34). Complication like skin lesion was found only in injection diclofenac sodium
group whereas cold sensation at the local site was typically found in diclofenac diethylamine gel
group.
Conclusion: Although not statistically significant, the mean pain score in locally applied analgesic
agents (EMLA and diclofenac diethylamine gel) is lower as compared to intramuscularly given diclofenac
sodium. Among these two locally acting drugs, diclofenac diethylamine gel is an equally
effective alternative to EMLA.