Preemptive administration of oral, fast-acting tapentadol compared to tramadol/ketoprofen i.m. to reduce acute pain during and after ESWL procedure in renal stone disease

Abstract

Introduction: Extracorporeal shock wave lithotripsy (ESWL) used to be performed under general anesthesia. Today, although it is a painful procedure, it is performed under analgosedation. The aim of the study was to determine the severity of acute pain associated with ESWL using two comparative protocols for preemptive analgesics: tramadol vs. ketoprofen plus tapentadol. Methods: A clinical prospective randomized cohort study included 200 patients of both sexes aged 18-80 years who were divided into two groups: group 1 received a combination of ketoprofen 100 mg/ tramadol 50 mg i.m. 30 minutes before surgery; group 2 received tapentadol IR 50 mg orally, 1 hour before surgery. Pain intensity (NRS) and complications were recorded before, during and at the end of the procedure, respectively. Results: No difference was found in the preoperative characteristics of patient population, size and localization of the stone. Dimensions of kidney-localized stones were significantly higher in group 2 compared to group 1 (T test .000). There was a statistically significant increase in pain intensity before and during the procedure as well as pain intensity decrease during and after the procedure in each group (T test .000). In group 2, 10% of patients experienced severe pain during the procedure, compared to 3%of patients in group 1 (Mann-Witney 0.005). In the severe pain subgroups of each patient group, drowsiness occurred in 5% of patients in group 2, which was significantly more than the 1% in group 1 (overall incidence in both groups was 25%). Conclusion: Although both protocols offered average moderate pain intensity during the procedure, severe pain and nausea were observed more frequently in the tapentadol group, which was related to stone size and JJ stent insertion.