Extracorporeal shock wave lithotripsy in traumatic quadriplegic patients: can it be safely performed without anesthesia?

A total of 5 traumatic quadriplegic patients underwent 10 extracorporeal shock wave lithotripsy treatments with either a local (bupivacaine 0.25 per cent) field block or no anesthesia. Significant intraoperative hypertension as determined by the anesthesiologist occurred in 2 patients and responded to intravenous hydralazine. The complete clinical syndrome of autonomic dysreflexia did not occur. Three patients are free of stones and 2 have insignificant residual caliceal fragments. Extracorporeal shock wave lithotripsy may be performed safely in traumatic quadriplegic patients without the added risk of general or regional anesthesia. It is recommended that during therapy these patients should be monitored closely by an anesthesiologist for the signs and symptoms of autonomic dysreflexia.