Brief Article
Copyright ©2010 Baishideng. All rights reserved.
World J Gastrointest Surg. May 27, 2010; 2(5): 165-168
Published online May 27, 2010. doi: 10.4240/wjgs.v2.i5.165
Epidural anesthesia is effective for extracorporeal shock wave lithotripsy of pancreatic and biliary calculi
Santosh Darisetty, Manu Tandan, Duvvuru Nageshwar Reddy, Rama Kotla, Rajesh Gupta, Mohan Ramchandani, Sandeep Lakhtakia, Guduru Venkat Rao, Rupa Banerjee
Santosh Darisetty, Rama Kotla, Department of Anesthesiology, Asian Institute of Gastroenterology, Hyderabad 500082, India
Manu Tandan, Duvvuru Nageshwar Reddy, Rajesh Gupta, Mohan Ramchandani, Sandeep Lakhtakia, Guduru Venkat Rao, Rupa Banerjee, Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, India
Author contributions: Darisetty S was responsible for the conception, design, analysis and interpretation of the data, drafting of the article, critical revision of the article for important intellectual content and final approval of the article; Tandan M, Reddy DN, Gupta R, Ramchandani M, Lakhtakia S, Rao GV and Banerjee R provided the collection of human material and the design of the manuscript; Kotla R helped with the procedures, patient data analysis and drafting of the article.
Correspondence to: Dr. Santosh Darisetty, Department of Anesthesiology, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad 500082, India. sant_dari@yahoo.com
Telephone: 91-40-23378888 Fax: 91-40-23324255
Received: February 5, 2010
Revised: March 17, 2010
Accepted: March 24, 2010
Published online: May 27, 2010
Abstract

AIM: To evaluate the efficacy of thoracic epidural analgesia for extracorporeal shock wave lithotripsy (ESWL).

METHODS: ESWL is an effective, non-invasive technique for the treatment of difficult pancreatic and large bile duct calculi. The procedure is often painful and requires large doses of analgesics. Many different anesthetic techniques have been used. Patients with either large bile duct calculi or pancreatic duct calculi which could not be extracted by routine endoscopic methods were selected. Thoracic epidural anesthesia (TEA) was routinely used in all the subjects unless contraindicated. Bupivacaine 0.25% with or without clonidine was used to block the segments D6 to D12. The dose was calculated depending on the age, height and weight of the patient. It was usually 1-2 mL per segment blocked.

RESULTS: Ninety eight percent of the 1509 patients underwent ESWL under TEA. The subjects selected were within American Society of Anesthesiologists grade I to III. ESWL using EA permitted successful elimination of bile duct or pancreatic calculi with minimal morbidity. The procedure time was shorter in patients with TEA than in those who underwent ESWL under total intravenous anesthesia.

CONCLUSION: Almost all patients undergoing ESWL with EA had effective blocks with a single catheter insertion and local anesthetic injection.

Keywords: Thoracic epidural anesthesia; Extracorporeal shock wave lithotripsy; Bile duct calculi; Pancreatic duct calculi