Published 2019-07-02
Riza Mazidu Sholihin Lukman Hakim Doddy M. Soebadi


Objective: The Extracorporeal Shockwave Lithotripsy (ESWL) procedure is the first choice for kidney stone therapy with the size ≤20mm. One of the complications of ESWL is the pain. Pain control during ESWL is essential to maintain the focus point of ESWL and give enough time to achieve complete stone fragmentation. Until now there is still no data about the effectiveness of Eutectic Mixture of Local Anesthetics (EMLA) cream as an adjuvant analgesic for ESWL procedure in Soetomo Hospital Surabaya. To compare the onset of pain and ESWL Wong-Baker Pain Scale (WBPS) between the EMLA group and placebo group. Material & Methods: The design of this study was a single-blind randomized control trial comparing the onset of pain and Wong Baker pain scale between the patient in EMLA group and placebo one. WBPS is assessed in minute 15, 30, 45, and 60 of ESWL sessions and 60 minutes post ESWL procedure. The results were analyzed with SPSS. Pain onset and differences of WBPS were tested by using independent T-test if the data is normally distributed and using Mann-Whitney test if the data is not normally distributed. Results: 10 patients were obtained in each group. The mean onset of pain in the EMLA group was longer than the mean onset of pain in the placebo group but statistically not significant (p>0.05). The WBPS in the EMLA group was significantly lower compared with the placebo group in the 30, 45, and 60 minutes of ESWL (p<0.05). Conclusion: EMLA cream application before ESWL was effective and safe as an adjuvant analgesic to reduce pain during ESWL.



Eutectic mixture of local anesthetics cream, extracorporeal shockwave lithotripsy, Wong-Baker pain scale


Purnomo BB. Batu saluran kemih. In: Purnomo BB. Dasar-Dasar Urologi, 3rd ed. Jakarta: Sagung Seto; 2011. p. 85-99.

Ikatan Ahli Urologi Indonesia (IAUI). Clinical Practice Guideline/Pedoman Penatalaksanaan Klinik (PPK) mengenai penatalaksanaan penyakit batu saluran kemih. Jakarta; 2007.

Stoller M, Meng M. Urinary stone disease, the practical guide to medical and surgical management. New Jersey; Humana Press: 2007. p. 27-35

Pearle MS, Antonelli JA, Lotan Y. Urinary lithiasis: Etiology, epidemiology and pathogenesis. In: Louis R. Kavoussi Alan J. Wein, Andrew C. Novick, Alan W. Partin, Craig A. Peters editor. Campbell Walsh Urology, 11th ed. Philadelphia; Elsevier Saunders. 2016; 2: 1170-99.

Bach C, Karaolides T, Buchholz N. Extracorporeal shock wave lithotripsy: What is new? Arab Journal of Urology. 2012; 10: 289-95.

Lingeman JE, Siegel YI, Steele B, Nyhuis AW, Woods JR. Management of lower pole nephrolithiasis: a critical analysis. J Urol. 1994; 151: 663-7.

Ridha M, Soebadi DM. ESWL for renal and ureteral stone. Indonesian Journal of Urology. 2014; 21: 56-62.

Turk C, Knoll T, Petrik A, Sarica K, Skolarikas A, Straub M, et al. Guidelines on urolithiasis European Association of Urology 2016. European Association of Urology; 2016. p. 1124-851.

Gupta PN, Kumar A. Analgesia for pain control during extracorporeal shock wave lithotripsy: Current status. Indian J Urol. Apr-Jun 2008; 24(2): 155-8.

Rao S, Ballesteros N, Short K, Gathani K. Extra corporeal shockwave lithotripsy resulting in skin burns-a report two cases; In press. Int Braz J Urol. 2014; 40.

Salinas AS, Lorenzo-Romero J, Segura M, Calero MR. The factor determining analgesic and sedative drug requirement during extracorporeal shock wave lithotripsy. Urol Int. 1999; 63: 92-101.

Basar H, Yilmaz E, Ozcan S, Buyukkocak U, Sari F, Apan A, et al. Four analgesic techniques for shock wave lithotripsy: eutectic mixture local anesthetic is a good alternative. J Endourol. Feb 2000; 17(1): 3-6.

Rahardjo D, Hamid R. Perkembangan penatalaksanaan batu ginjal di RSCM tahun 1997-2002. J I Bedah Indonesia. 2004; 32(2): 58-63.

Grasso M. Extracorporeal shockwave lithotripsy. Director of Endourology, Lenox Hill Hospital; Professor and Vice Chairman, Department of Urology. New York Medical College; 2007. HTM.

Kumar A, Gupta N, Hemal A, Wadhwa P. Comparison of three analgesic regimen for pain control during shockwave lithotripsy using Dornier delta compact lithotriptor: A randomized clinical trial. Acute pain; 2007: 9(4): 230.

Gajraj NM, Pennant JH, Watcha MF. Eutectic mixture of local anesthetics (EMLA) cream. Anesth Analg. 1994; 78: 574-83.

Monk TG, Ding Y, White PF, Albala DM, Clayman RV. Effect of the eutectic mixture of local anesthetics on pain response and analgesic requirement during lithotripsy procedures. Anesth Analg. 1994; 79: 506–11.

Basar H, Yilmaz E, Ozcan S, Buyukkocak U, Sari F, Apan A, et al. Four analgesics techniques for shock wave lithotripsy: Eutectic mixture local anesthesia is a good alternative. Journal of Endourology. 2003; 17(1): 3-6.

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Department of Urology, Faculty of Medicine/Airlangga University