THE EFFECTS OF GENERAL VERSUS EPIDURAL-ANESTHESIA FOR OUTPATIENT EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY

Although many anesthetic techniques are described for immersion extrac orporeal shock wave lithotripsy (ESWL), regional and TV techniques are the most commonly reported. This randomized, prospective study compar ed general anesthesia (GA) and epidural anesthesia (EPID) with regard to effectiveness, side effects, induction time, and recovery in patien ts undergoing ESWL using an unmodified Dornier HM-3 lithotriptor. Twen ty-six healthy outpatients were randomized to GA (propofol, N2O, laryn geal mask airway) or EPID (lidocaine 1.5% with epinephrine). Intraoper ative and postoperative supplemental medications, side effects, and co mplications were noted. Induction times and times required to meet sta ndard recovery criteria were compared between groups. Patients were su rveyed regarding their satisfaction with anesthesia. All patients in t he EPID group had effective blocks with a single catheter insertion an d local anesthetic injection. In the GA group, the LMA was inserted su ccessfully in all patients. Time from loom entry to procedure start wa s significantly less in the GA group (23 +/- 11 vs 34 +/- 9 min; P < 0 .05). Patients in the GA group were ready for discharge home earlier ( 127 +/- 59 vs 178 +/- 49 min; P < 0.05). Only three patients experienc ed nausea tone in the GA group, two in the EPID group). There were no differences in patient or urologist satisfaction with anesthesia. We c onclude that GA is associated with a rapid recovery compared with EPID . Implications: General anesthesia with propofol, nitrous oxide, and a laryngeal mask airway is comparable to epidural anesthesia with lidoc aine for outpatient extracorporeal shock wave Lithotripsy procedures. However, early recovery is more rapid after general anesthesia compare d with epidural anesthesia.