ABSTRACT Background Shock wave lithotripsy (SWL) is the first line treatment modality for a significant proportion of patients with upper urinary tracts stones. Simple analgesics, opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are all suitable agents but the relative efficacy and tolerability of these agents is uncertain. Objectives To determine the efficacy of the different types of analgesics used for the control of pain during SWL for urinary stones. Materials and Methods We searched the Cochrane Renal Group’s Specialised Register, MEDLINE, EMBASE and also hand-searched reference lists of relevant articles (Figure-1). Randomised controlled trials (RCT’s) comparing the use of any opioid, simple analgesic or NSAID during SWL were included. These were compared with themselves, each-other or placebo. We included any route or form of administration (bolus, PCA). We excluded agents that were used for their sedative qualities. Data were extracted and assessed for quality independently by three reviewers. Meta-analyses have been performed where possible. When not possible, descriptive analyses of variables were performed. Dichotomous outcomes are reported as relative risk (RR) and measurements on continuous scales are reported as weighted mean differences (WMD) with 95% confidence intervals. Results Overall, we included 9 RCTs (539 participants from 6 countries). Trial agents included 7 types of NSAIDs, 1 simple analgesic and 4 types of opioids. There were no significant differences in clinical efficacy or tolerability between a simple analgesic (paracetamol) and an NSAID (lornoxicam). When comparing the same simple analgesic with an opioid (tramadol), both agents provided safe and effective analgesia for the purpose of SWL with no significant differences. There were no significant differences in pain scores between NSAIDs or opioids in three studies. Adequate analgesia could be achieved more often for opioids than for NSAIDs (RR 0.358; 95% CI 043 to 0.77, P=0.0002) but consumed doses of rescue analgesia were similar between NSAIDs and opioids in two studies (P=0.58, >0.05). In terms of tolerability, there is no difference in post-operative nausea and vomiting (PONV) between the groups (RR 0.72, 95% CI 0.24 to 2.17, P=0.55). One study compared outcomes between two types of NSAIDs (diclofenac versus dexketoprofen). There were no significant differences in any of our pre-defined outcomes measures. Conclusion Simple analgesics, NSAIDs and opioids can all reduce the pain associated with shock wave lithotripsy to a level where the procedure is tolerated. Whilst there are no compelling differences in safety or efficacy of simple analgesics and NSAIDs, analgesia is described as adequate more often for opioids than NSAIDs.

WHO and the United Nations Children's Fund (UNICEF) annually review data on immunization coverage to estimate national coverage with routine service delivery of the following vaccines: bacille Calmette-Guérin; diphtheria-tetanus-pertussis, first and third doses; either oral polio vaccine or inactivated polio vaccine, third dose of either; hepatitis B, third dose; Haemophilus influenzae type b, third dose; and a measles virus-containing vaccine, either for measles alone or in the form of a combination vaccine, one dose. The estimates are based on government reports submitted to WHO and UNICEF and are supplemented by survey results from the published and grey literature. Local experts, primarily national immunization system managers and WHO/UNICEF regional and national staff, are consulted for additional information on the performance of specific immunization systems. Estimates are derived through a country-by-country review of available data informed and constrained by a set of heuristics; no statistical or mathematical models are used. Draft estimates are made, sent to national authorities for review and comment and modified in light of their feedback. While the final estimates may not differ from reported data, they constitute an independent technical assessment by WHO and UNICEF of the performance of national immunization systems. These country-specific estimates, available from 1980 onward, are updated annually.

La OMS y el Fondo de las Naciones Unidas para la Infancia (UNICEF) analizan cada año los datos sobre la cobertura de vacunación para calcular la cobertura nacional de los servicios de administración sistemática de las siguientes vacunas: bacilo de Calmette-Guérin; difteria-tétanos-tos ferina, primera y tercera dosis; vacuna antipoliomielítica oral o inactivada, tercera dosis de cualquiera de ellas; hepatitis B, tercera dosis; Haemophilus influenzae tipo b, tercera dosis; y una vacuna contra el virus del sarampión, ya sea sólo contra esta enfermedad o en forma de vacuna combinada, una dosis. Las estimaciones están basadas en los informes presentados por los gobiernos a la OMS y el UNICEF, complementados por resultados procedentes de diversas publicaciones y de la literatura gris. Se consulta además a expertos locales, principalmente responsables de los sistemas nacionales de inmunización y personal regional y nacional de la OMS y el UNICEF, para reunir información adicional sobre la eficacia de sistemas de inmunización concretos. Las estimaciones se basan en un análisis por países de los datos disponibles, fundamentado y limitado por un conjunto de reglas empíricas; no se emplean modelos estadísticos ni matemáticos. Las estimaciones preliminares son enviadas a las autoridades nacionales para que las examinen y formulen observaciones, y se modifican en función de esa retroinformación. Aunque no siempre distintas de los datos notificados, las estimaciones finales pueden considerarese el resultado de una evaluación técnica independiente realizada por la OMS y el UNICEF sobre el desempeño de los sistemas nacionales de inmunización. Disponibles desde 1980, estas estimaciones específicas para cada país son actualizadas cada año.

L'OMS et le Fonds des Nations Unies pour l'enfance (UNICEF) révisent chaque année les données de couverture vaccinale pour estimer les couvertures des pays par les services de vaccination systématique dans le cas des vaccins suivants : BCG, vaccin antidiphtérique-antitétanique-anticoquelucheux, première et troisième doses, vaccin antipoliomyélitique oral ou inactivé, troisième doses, vaccin contre l'hépatite B, troisième doses, vaccin contre Haemophilus influenzae type b, troisième dose ; et vaccin à valence rougeole, sous forme de vaccin antirougeoleux uniquement ou de vaccin combiné, une dose. Ces estimations reposent sur les rapports soumis par les gouvernements à l'OMS et à l'UNICEF et sont complétées par des résultats d'enquêtes, tirés de la littérature grise ou publiée. Des experts locaux, principalement des gestionnaires de systèmes de vaccination nationaux et des membres du personnel régional ou national de l'OMS et de l'UNICEF, sont complémentaires consultés pour obtenir des informations sur les performances de certains systèmes de vaccination. Les estimations sont obtenues à partir d'une analyse par pays des données disponibles, étayée et encadrée par un ensemble d'hypothèses heuristiques ; on ne recourt à aucun modèle statistique ou mathématique. Des estimations préliminaires sont établies, envoyées aux autorités nationales pour examen et commentaires et modifiées à la lumière des observations reçues. Bien que les estimations finales puissent ne pas différer des données rapportées, elles constituent une évaluation technique indépendante par l'OMS et l'UNICEF des performances des systèmes de vaccination nationaux Ces estimations par pays, disponibles depuis 1980, sont actualisées chaque année.