Mg. Richardson et Jw. Dooley, THE EFFECTS OF GENERAL VERSUS EPIDURAL-ANESTHESIA FOR OUTPATIENT EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY, Anesthesia and analgesia, 86(6), 1998, pp. 1214-1218
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.