(S-5) Green, J.A., Tuesday 7:00
TITLE: INTRATHECAL SUFENTANIL ENHANCES RECOVERY FOR OUTPATIENT EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY WHEN COMPARED TO GENERAL ANESTHESIA
AUTHORS: Jeffrey A. Green, MD, Wei C. Lau, MD, Carmen R. Green, MD, Alan R. Tait, PhD
AFFILIATION: University of Michigan, Ann Arbor, MI.
INTRODUCTION: Many anesthetic techniques are currently used for extracorporeal shock wave lithotripsy (ESWL). Recent studies have demonstrated the efficacy, safety, and enhanced recovery profile of intrathecal sufentanil (ITS) compared to intrathecal lidocaine for outpatient ESWL (1). General anesthesia (GA) has been shown to be an effective alternative with shorter discharge time when compared to epidural anesthesia using lidocaine for outpatient ESWL (2). However, GA has not been compared to ITS.
METHODS: IRB approval and informed consent were obtained for this study. Eleven adult patients scheduled for outpatient ESWL were randomized to receive GA or ITS. ITS 20µg was administered via standard midline subarachnoid puncture, at the L1-2 interspace, using a 25-gauge Whitaker needle. No additional opioid analgesics were administered during the intraoperative period. GA was induced with propofol 2mg/kg IV and the airway was maintained with a laryngeal mask airway (LMA). Anesthesia was maintained with propofol 100-200mcg/kg/min IV and 70% N2O in O2 with patients breathing spontaneously. Postoperative pain was treated with 25-50 mcg of IV fentanyl. The patient's level of pain, utilization of analgesics. and recovery profile were tabulated. Data was analyzed by chi-square contingency table and Wilcoxon Rank Sum where appropriate.
RESULTS:
|
|
Intrathecal Sufentanil |
GA |
|
No. of Patients (n) |
6 |
5 |
|
Postoperative IV Analgesic n (%) |
0 (0)* |
3 (60) |
|
Time to Ambulation (Mean + SD) |
53 ± 11* |
98 ± 18 |
|
Time to Discharge (mean ± SD)) |
73 ± 10* |
125 ± 36 |
P<0.05 vs. general anesthesia (GA)
DISCUSSION: This study demonstrated ITS was superior to GA in recovery and home discharge. Time to discharge for GA was consistent with previous studies (2). These results are explained by the capability of ITS patients to bypass PACU Phase I and be directly admitted to PACU Phase II since discharge criteria for PACU Phase I was met. GA patients required admission to PACU phase I, then to PACU phase II prior to home discharge. Our study shows that ITS has an enhanced recovery profile hastening discharge while achieving high patient satisfaction when compared to GA.
REFERENCES:
Anesth Analg 1997; 84:1227-31.
Anesth Analg 1998; 86:1214-8.