The Effects of General Versus Epidural Anesthesia for Outpatient Extracorporeal Shock Wave Lithotripsy

Abstract

Although many anesthetic techniques are described for immersion extracorporeal shock wave lithotripsy (ESWL), regional and IV techniques are the most commonly reported.This randomized, prospective study compared general anesthesia (GA) and epidural anesthesia (EPID) with regard to effectiveness, side effects, induction time, and recovery in patients undergoing ESWL using an unmodified Dornier HM-3 lithotriptor. Twenty-six healthy outpatients were randomized to GA (propofol, N2 O, laryngeal mask airway) or EPID (lidocaine 1.5% with epinephrine). Intraoperative and postoperative supplemental medications, side effects, and complications were noted. Induction times and times required to meet standard recovery criteria were compared between groups. Patients were surveyed regarding their satisfaction with anesthesia. All patients in the EPID group had effective blocks with a single catheter insertion and local anesthetic injection. In the GA group, the LMA was inserted successfully in all patients. Time from room entry to procedure start was 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 experienced nausea (one in the GA group, two in the EPID group). There were no differences in patient or urologist satisfaction with anesthesia. We conclude 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 lidocaine for outpatient extracorporeal shock wave lithotripsy procedures. However, early recovery is more rapid after general anesthesia compared with epidural anesthesia. (Anesth Analg 1998;86:1214-8)