Faculty Collaboration Database

A comparison of epidural narcotics, with and without a test dose, to epidural lidocaine for extracorporeal shock wave lithotripsy. Reg Anesth 1990;15(6):288-94

Date

11/01/1990

Pubmed ID

2149829

Scopus ID

2-s2.0-0025614963 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

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 micrograms alfentanil (Group A), 200 micrograms fentanyl (Group F) or 60 micrograms 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 less than 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 less than 0.01). Sedation was observed in all of the narcotic groups, particularly in Group S-, in which more than half of patients were drowsy (p less than 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.(ABSTRACT TRUNCATED AT 250 WORDS)

Author List

Madsen KE, Stowe DF, McDonald DJ, Ebert TJ, Kampine JP

Authors

Karin E. Drescher MD Adjunct Associate Professor in the Anesthesiology department at Medical College of Wisconsin
Thomas J. Ebert MD, PhD Adjunct Professor in the Anesthesiology department at Medical College of Wisconsin
David F. Stowe MD, PhD Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Alfentanil
Analgesia, Epidural
Epinephrine
Female
Fentanyl
Humans
Lidocaine
Lithotripsy
Male
Middle Aged
Sufentanil