Multimodal spinal anesthesia.

BACKGROUND AND

OBJECTIVES

Cystoscopy and extracorporeal shock wave lithotripsy (ESWL) are common urologic procedures in the treatment of ureteral calculi. Spinal anesthesia with local anesthetics is the anesthetic technique of choice for these procedures. Sufentanil and/or clonidine have been combined with local anesthetics to provide effective and safe neuroaxial anesthesia. Our objectives were to review the efficacy and safety of combining both sufentanil and clonidine with reduced doses of intrathecal lidocaine in patients undergoing cystoscopy and ESWL.

METHODS

We reviewed the medical records of 12 patients who underwent such urologic procedures using an intrathecal mixture consisting of 20 mg of lidocaine, 10 micrograms of sufentanil, and 50 micrograms clonidine from May 1st, 1998 to December 31st, 1998. Patients' demographics, intraoperative analgesia and adverse side effects as well as recovery times were reviewed.

RESULTS

All 12 patients tolerated their urologic treatments using this combination of drugs without requiring conversion to another anesthetic technique or significant supplementation with intravenous analgesics. Motor power returned to normal by the end of the procedure. The systolic blood pressure dropped 26 +/- 8% intra-operatively and 25 +/- 9% postoperatively. The incidences of other adverse side effects were low. Time spent in recovery area was short, 45 +/- 15 minutes (mean +/- standard deviation).

CONCLUSIONS

Intrathecal admixtures of sufentanil 10 micrograms, clonidine 50 micrograms, and lidocaine 20 mg can provided effective and prolonged analgesia in patients undergoing cystoscopy and ESWL. Patients had recovery of their motor power in their lower extremities by the end of the procedure. No urinary retention was noted. Mild hypotension was the most common adverse side effect and was the main confounding factor for the prolongation of the discharge time.