Comparison of shockwave lithotripsy outcomes in patients receiving sufentanil or lidocaine spinal anesthesia

Purpose. To determine whether the use of intrathecal sufentanil, which allo ws the patient to move during shockwave lithostripsy (SWL), affects treatme nt outcomes and operative and recovery times compared with standard lidocai ne spinal anesthesia. Patients and Methods. We retrospectively studied a series of 62 SWL procedu res performed on an unmodified Dornier HM3 lithotripter. The mean calculus size was 10.7 mm. There were 46 renal calculi, 13 ureteral calculi, and 4 p atients with calculi in both locations. Of the 63 procedures, 25 were perfo rmed using intrathecal sufentanil alone, and 37 were performed with intrath ecal lidocaine with or without additional agents. We compared treatment out comes, as well as treatment time, fluoroscopy time, postanesthesia care uni t (PACU) time, time to voiding, and time to ambulation. Results. Sufentanil use was associated with a significantly higher rate of successful treatment, defined as residual fragments absent or <4 mm on foll ow-up imaging, compared with lodocaine: 68% v. 40% (p = 0.0394). There was no significant difference between the groups in treatment time or fluorosco py time. Use of sufentanil was associated with significantly shorter PACU t ime, time to ambulation, and rime to voiding postoperatively, These differe nces persisted when men and women were analyzed separately, although the di fferences were less significant in women. Conclusions. The use of intrathecal sufentanil for anesthesia during SWL do es not adversely affect treatment outcome; it is, in fact, associated with better outcomes. The advantages of this agent in shortening recovery times and in easing patient transfer into the HM3 gantry argue for increasing its use.