[Comparison of intravenous alfentanil, fentanyl and epidural lidocaine for extracorporeal shock wave lithotripsy].

Abstract

Due to the development of newer generation of lithotriptor, the anesthesia for extracorporeal shock wave lithotripsy (ESWL) was variable recently. To compare opioid analgesia with epidural lidocaine for their efficacy in pain control, hemodynamic changes, side effects and patient acceptance during ESWL, sixty unpremedicated patients undergoing elective ESWL for upper urinary calculi with second generation Dornier MFL 5000 nonimmersion lithotriptor were randomly assigned equally into one of the following managements: Group E: 1% epidural lidocaine with 1:200000 epinephrine; Group A: 15 micrograms/kg alfentanil initially and 7 micrograms/kg on demand intravenously; Group F: 4 micrograms/kg fentanyl initially and 2 micrograms/kg on demand intravenously. Significant hypotension and bradycardia occurred in Gp.E as compared to baseline value (p < 0.05). Early respiratory depression was observed in both Gp. A and Gp. F, but Gp. A showed significantly shorter period (2 to 5 minutes) as compared to Gp.F (2 to 15 minutes). Under the insufflation of oxygen by nasal cannula, mean PaCO2 increased maximally to 50 mmHg, but no arterial oxygen desaturation (< 90%) was noted in Gp.A and Gp.F. The incidence of post-ESWL nausea was higher in Gp.F (p < 0.05), shivering and delayed recovery time were the main disturbing problems in Gp.E (p < 0.01). Although five-point verbal pain scale was significantly higher in Gp.A and Gp.F (at 30 to 45 minutes during ESWL) as compared to Gp.E, acceptance among patients was high throughout the course. We conclude that different anesthetic plans should be determined on different lithotriptors settings and patient's physical condition.(ABSTRACT TRUNCATED AT 250 WORDS)