A comparison of epidural narcotics, with and without a test dose, to epidural lidocaine for extracorporeal shock wave lithotripsy
Madsen, K.E.; Stowe, D.F.; McDonald, D.J.; Ebert, T.J.; Kampine, J.P.
Regional Anesthesia 15(6): 288-294
1990
ISSN/ISBN: 0146-521X PMID: 2149829 Document Number: 356198
We sought to compare epidural lidocaine to several short-acting epidural narcotics for their efficacy in controlling pain during extracorporeal shock wave lithotripsy (ESWL), hemodynamic changes, side effects and patient acceptance. To determine what contribution, if any, the local anesthetic test dose makes to the above factors, we also compared epidural sufentanil with and without a preceding test dose of local anesthetic with epinephrine. One hundred ASA I-III patients scheduled for elective ESWL were divided equally into five groups to receive one of the following epidural drugs through an epidural catheter: 2% lidocaine with 1:200,000 epinephrine (Group L), 1000 .mu.g alfentanil (Group A), 200 .mu.g fentanyl (Group F) or 60 .mu.g sufentanil (Groups S and S-). Group S- differed from all other groups in omission of the test dose and direct injection of the opioid through the epidural needle. Significant hypotension occurred in 20% of patients in Group L compared to 0% in the narcotic groups (p < 0.01). Clinically significant respiratory depression was not observed in any group. Mild pruritus was observed in up to 60% of patients in the narcotic groups (p < 0.01). Sedation was observed in all of the narcotic groups, particulary in Group S-, in which more than half of patients were drowsy (p < 0.05). Requirements for adjuvant analgesics during ESWL were highest in Group A. Patient acceptance was high throughout the study. We conclude that epidural alfentanil, fentanyl and sufentanil are as effective as epidural lidocaine plus epinephrine in providing analgesia during ESWL. Lack of discernible sensory block after epidural opioids is a potential disadvantage but avoidance of hypotension is desirable in patients with cardiovascular or cerebrovascular disease.