Evaluation and management of post-shock wave lithotripsy pain with third-generation lithotriptors using rofecoxib.

INTRODUCTION Newer generation lithotriptors have been modified to induce less pain. We evaluated factors contributing to post-shock wave lithotripsy (SWL) pain and assessed potential benefits of preemptive analgesia using Rofecoxib, a COX-II inhibitor, and potential effects on stone passage rates. MATERIALS AND METHODS Sixty-nine patients were evaluated. Thirty-eight percent were women and 62% men, with a mean age of 53. Seventy-four patients treated using Dornier lithotriptor-50 were enrolled in a prospective, double-blind, randomized study. The study group received 50 mg of rofecoxib 1 hour before extracorporeal shockwave lithotripsy (ESWL) and 24 hours later. The control group received no pretreatment medications. All patients were discharged with narcotic medications and contacted on postoperative days (POD) 1, 3, and 7. Questionnaires were administered to assess pain control using a numeric pain scale. RESULTS Seventy-two percent had renal stones, and 28% ureteral, with a mean size of 10 mm. The mean pain score was 4.2 immediately after SWL, 3.4 on POD 1, 1.9 on POD 3, and 0.6 on POD 7. Multivariate analysis revealed a significant decrease in pain with time (p < 0.0001). Patients with severe pain before SWL had more pain after treatment (p = 0.003). Older patients had less pain post-SWL (p = 0.045). Pretreatment with Rofecoxib significantly reduced post-SWL pain from 5.04 to 4.03 (p < 0.0001). Other variables had no effect on posttreatment pain. CONCLUSIONS Pain after SWL is moderate to severe using third-generation lithotriptors and is significantly reduced by POD 3. Younger patients and those with significant pretreatment pain had more pain after treatment. Preemptive Rofecoxib reduced post-SWL pain, but had no impact on stone passage.