Since its introduction nearly three decades ago, extracorporeal lithotripsy has become an established treatment for kidney and ureteric stones. Treatment using early lithotripsy devices was efficacious but painful, requiring general anaesthesia. Modern lithotripters are better tolerated: shock wave lithotripsy (SWL) is now usually an outpatient procedure undertaken after administration of analgesia, with or without sedation. Many different analgesia regimens have been investigated. In this article the characteristics of the ideal painkiller for shock wave lithotripsy are described and evidence of the suitability of a variety of different analgesic protocols is reviewed.
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