Slide 1

<= /div>

‹h= eader›

<= /div>

‹date/time›

<= /div>

‹f= ooter›

<= /div>

‹#›

------=_NextPart_01C62B28.18552FC0 Content-Location: file:///C:/51965904/PosterEpiduralMep-Revised_files/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C62B28.18552FC0 Content-Location: file:///C:/51965904/PosterEpiduralMep-Revised_files/slide0002.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Slide 1

SINGLE DOSE EPIDURAL MEPERIDINE VERSUS CONSCIOUS SEDATION FOR EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY: A RETROSPECTIVE ANALYSIS

Gregory K. Applegate, D.O., Thomas. J. Kunkel, M.D., David Kazdan, M.D., Donald M. Voltz, M.D.
University Hospitals of Cleveland and Case Western Reserve Univers= ity, Cleveland, Ohio

<= /div>

RESULTS:

Postoperative complaints differed between the EPI-M and CS groups.= In the CS group, pain was the most common post-operative complaint occurring in 4 of 15 patients (27%), which required administration of opioids in all cases. Nausea or vomiting oc= curred in 3 of 15 patients (20%) who underwent CS. Urinary retention was uncommon, occurring in 1 of 15 patients (7%). In the EPI-M group by contrast, pain was a complaint in 2 of 63 patients (3%). One patient required no medication and the other received nalbuphine for treatment of concomitant urinary retention. Pruritus occurred in 7 of 63 patients (11%) who received EPI-M, and= of these patients, 6 of 7 required treatment with naloxone, nalbuphine or diphenhydramine. Urinary ret= ention occurred in 17 of 63 patients (27%) and 5 of these patients required treatment. The treatment for urinary retention included nalbuphine, naloxone, bethanechol, or bladder catheterization. One patient= had a near syncopal episode related to attempted micturation that was treated wi= th atropine and bethanechol. The patient was discharged to home after further observation in phase two recovery. No patient in the = EPI-M group required hospital admission.

REFERENCES:

1.Chaussy CG, Schuller J, Schmidt E, et al. Urology 1984;23:59-66

2.Ngan Kee WD. Anest Intens Care 1998;26:137-1463.Cousins MJ, Mather LE. Anesthesiology 1984;61:276-3= 10

DISCUSSION:

ESWL is the most common treatment for urinary stones that requires an anesthetic. The anesthetic technique should minimize risk to the patient, provide adequate analgesia, and promote early ambulation. Meperidine produ= ces peripheral sensory and motor blockade after intrathecal injection.<= span style=3D'font-family:Arial;mso-ascii-font-family:Arial;mso-bidi-font-famil= y: Arial;font-size:55%;position:relative;top:-.45em;mso-text-raise:30%'>3 Early ambulation is possible due to the minimal motor blockade of meperidine whi= le the analgesic effect appears to be prolonged. The net result of these effects w= ould appear to be consistent with early discharge of the outpatient. In this series, the effectiveness= of EPI-M was limited by the high rate of pruritus and urinary retention, alth= ough no patient required prolonged treatment and all patients were discharged to home. Even though CS may all= ow for early ambulation and discharge in this series, it was related to a higher = rate of post-operative pain. We found that both EPI-M and CS appeared to be equ= ally efficacious and safe, but with different side effect profiles.

<= b>INTRODUCTION:

Extracorporeal shock wave lithotripsy (ESWL) has become the procedure of choice for the treatment of stones of the kidney and ureter.1 Anesth= esia is required for patient comfort and a motionless treatment field. When ESWL is performed remote fro= m the operating room and in a water bath, loss of airway control is a constant concern during general anesthesia. Epidural analgesia using drugs chosen to avoid motor blockade has t= he potential to be effective in surgical and post-operative pain management.<= span style=3D'mso-spacerun:yes'> Epidural analgesia using a single= dose local anesthetic, with or without an opioid in the solution, followed by conscious sedation (CS) during the ESWL procedure appears to be a safe and effective method of anesthesia.2 We dis= cuss the use of epidural meperidine (EPI-M), a single drug acting as both local anesthetic and opioid for this procedure.

METHODS:

The records of patients who underwent ESWL with single dose EPI-M or CS were retrospectively reviewed. Us= ing descriptive statistics, we compared demographic characteristics and the incidence of side effects of EPI-M with a second cohort that had the same procedure performed under CS during the same time period. Seventy-eight patients underwent = ESWL with EPI-M (63 patients) or CS (15 patients) in a community hospital setti= ng. The average age for the EPI-M and= CS groups was 48.3 years old (range 20-77) and 49.5 years old (range 23-87), respectively. The ASA physic= al status ranged from I to IV, however, most patients were ASA physical status II. The groups were also comparable for clinical times, number of shocks, and duration of the procedure. Institutional rev= iew approval was waived for this retrospective chart review.

•53

•47

•BMI > 30 % (= %)

•2 (1-3= )

•2 (1-4= )

•ASA classificat= ion

•48.3 (= 20-77)

•49.5 (= 23-87)

•Averag= e age (years)

•32

•40

•Percen= tage of female Pts (%)

•63

•15

•Number of patie= nts

Epidural meperidine

•Consci= ous sedation

•

•33%

•

•46%

•Blood Pressure Change

•(± 20%)<= /span>

•129= 3;

•(45-32= 0)

•132= 3;

•(35-24= 5)

•Phase = II recovery (min)

•38 = ;

•(20-16= 5)

•34 = ;

•(15-60= )

•Phase = I recovery (min)

•63 = 3;

•(20-13= 0)

•61 = ;

•(35-10= 5)

•Surgery (min)

•103= 3;

•(55-16= 5)

•91 = ;

•(55-15= 0)

•Anesth= esia (min)

•3067 &= #13;

•(800-7= 200)

•2955 &= #13;

•(1500-= 5300)

•Number= of shocks

•Epi= dural meperidine

•Con= scious Sedation

•

•27%= 3;

•(17/63= pts)

•7% = ;

•(1/15 = pts)

•Urinar= y Retention

•11%= 3;

•(7/63 = pts)

•0% = ;

•(0/15 = pts)

•Pruritus=

•0% = ;

•(0/63 = pts)

•20%= 3;

•(3/15 = pts)

•Nausea/Vomiting=

•3% = ;

•(2/63 = pts)

•27%= 3;

•(4/15 = pts)

•Post-o= perative pain

Epidural Meperidine

•Con= scious Sedation

•

Clinical Data & Procedural Times

Patient Demographic Data

Comparison of Side Effects

------=_NextPart_01C62B28.18552FC0 Content-Location: file:///C:/51965904/PosterEpiduralMep-Revised_files/slide0002.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8"