British Journal of Anaesthesia, 1989, Vol. 62, No. 1 82-86
© 1989 The Board of Management and Trustees of the British Journal of Anaesthesia
research-article |
EXTRADURAL BUPIVACAINE AND METHADONE FOR EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY
Department of Anesthesiology, Hadassah University Hospital Jerusalem, Israel
Department of Urology, Hadassah University Hospital Jerusalem, Israel
*Present address, for correspondence: Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Tower 711 Baltimore, MD 21205, U.S.A.
Combined extradural bupivacaine and methadone analgesia was investigated in 144 patients who underwent extracorporeal shock wave lithotripsy (ESWL). Patients were assigned randomly to one of three groups: group I—extradural 0.5% bupivacaine hydrochloride 0.75 mg kg–1; group II—extradural 0.1% methadone hydrochloride 4 mg after the bupivacaine; group III—as group II, plus a continuous extradural infusion of methadone 0.3 mg h–1 after operation. In all patients, only partial motor deficit occurred. During ESWL, patients who received extradural bupivacaine and methadone had significantly less pain compared with those who had bupivacaine alone (P < 0.025). Extradural anaesthesia and immersion in the warm water bath were accompanied by only mild fluctuations in arterial pressure. After ESWL, significantly more patients with continuous methadone infusion were pain free (P < 0.05) and they required less systemic analgesics. The anaesthesia during and after the ESWL procedure may be carried out safely and effectively by the administration of small doses of bupivacaine combined with methadone followed by infusion of the opioid.
Presented at the American Society of Anesthesiologists Annual Meeting, Atlanta Georgia, October 1987.
This article is dedicated to the memory of Professor J. T. Davidson, who died during its preparation.