Nefopam Analgesia as a Substitute of Neurolept Analgesia for Extracorporeal Shock Wave Lithotripsy

Abstract

To the Editor: Pain is an important side effect of extracorporeal shock wave lithotripsy (ESWL). It causes patient discomfort, movements, and tachypnea. We evaluated the efficiency of nefopam hydrochloride, a centrally acting nonnarcotic analgesic, in 197 consecutive patients (mean age 53 yr, range 23–86 yr) treated for renal stones by ESWL, using the piezoelectric EDAP LT-02 lithotriptor (EDAP, Lyon, France). Nefopam (20 mg) was administered IV over 30 min before ESWL. At the end of the session, patients were asked to assess their satisfaction with pain control using a four-point verbal scale. A total of 26.9% of patients reported no pain, 36.5% reported minimal pain, 30.5% moderate but tolerated pain, and 6.1% severe or untolerated pain necessitating interruption of the session. Nefopam was efficient in 94% of cases, ESWL session being conducted with the power and duration planned by the urologist (mean 44 min, range 25–62 min). No hemodynamic changes or oxygen desaturation were noted. The following minor side effects occurred in 14.7% of patients: nausea (8.6%), sedation (5.1%), and vomiting, hypotension, and drowsiness (0.5%). Nefopam is not structurally correlated to nonsteroidal antiinflammatory drugs or morphine-like drugs and so it is free of their serious side effects and contraindications. It inhibits the neuronal uptake of dopamine, serotonin, and noradrenaline in supraspinal and spinal levels, and increases neurotransmission in pain inhibitory serotoninergic descending pathways (1,2). As analgesic requirements during ESWL are difficult to predict, we recommend routine nefopam administration to reduce the incidence of treatment failure and avoid stressful pain experience. Fouad Atallah MD Thérèse Bastside-Heulin MD Kamran Samii MD Pierre Plante MD*