Overview
This study aims to evaluate the efficacy of acupressure applied to the LI4 (Hegu) and Qiu points before Extracorporeal Shock Wave Lithotripsy (ESWL) in patients with kidney or proximal ureteral stones. The study compares intraprocedural pain scores and procedural tolerance between an acupressure group, a sham acupressure group, and a standard care control group.
Description
Extracorporeal shock wave lithotripsy (ESWL) is a widely used non-invasive treatment for urinary tract stones; however, procedure-related pain can lead to patient movement and irregular breathing, which may reduce treatment efficacy and cause premature termination of the session. To manage this pain without the adverse effects associated with pharmacological agents, this prospective, randomized, sham-controlled, three-arm clinical trial evaluates the analgesic efficacy of acupressure during ESWL. A total of 105 eligible adult patients scheduled for their first ESWL session will be randomly assigned in a 1:1:1 ratio to an acupressure group, a sham group, or a standard care control group. Immediately prior to the procedure, the acupressure group will receive rhythmic thumb pressure on the bilateral LI4 (Hegu) and stone-side Qiu points for a total of 9 minutes (3 minutes per point). The sham comparator group will receive superficial touch on the exact same points for the same duration without therapeutic pressure, effectively blinding the patients to the intervention. The control group will receive standard care with no additional pre-procedural physical intervention. Throughout the ESWL procedure, pain severity will be systematically monitored using a 10-cm Visual Analogue Scale (VAS) at baseline, 10, 20, 30, and 40 minutes, and at the end of the procedure. Additionally, secondary outcomes including procedural intolerance, the need for rescue analgesia, changes in hemodynamic parameters (heart rate and blood pressure), overall patient satisfaction, and stone-free rates at three weeks post-procedure will be recorded to determine if acupressure serves as a safe and effective complementary analgesic method.
Eligibility
Inclusion Criteria:
- Patients scheduled for ESWL due to kidney or proximal ureteral stones.
- First-time ESWL patients.
- Age ≥ 18 years.
Exclusion Criteria:
- Kidney anomaly (e.g., horseshoe kidney) or severe hydronephrosis.
- Morbid obesity.
- Chronic neuropathic disease that may affect pain perception or neural response to acupressure.
- Use of any analgesics within \[12/24\] hours prior to the procedure.
- Use of anticoagulants.
- Impaired skin integrity (wound, infection, tenderness) at the acupressure application sites (LI4 or Qiu).
- Amputation of the relevant extremity.
