Intrathecal (IT)
sufentanil provides effective
analgesia for extracorporeal
shock wave
lithotripsy. However, the optimal dose of
sufentanil has not been established. We designed a prospective, randomized, double-blinded study to determine the optimal dose of IT
sufentanil. Sixty men were randomized to receive 12.5,15,17.5, or 20 microg of IT
sufentanil (n = 15 for each group) via a combined spinal epidural technique. Inadequate
analgesia was treated with IV
propofol, and the epidural was activated for a
pain score greater than 6 on a 10-point verbal analog
pain scale. Intraoperative and postoperative visual analog
pain scale scores were significantly higher in the 12.5-microg group compared with 20-microg group (3.2 +/- 1.6 vs 1.6 +/- 1.2, P < 0.05, and 1.1 +/- 0.5 vs. 0.5 +/- 0.4, P < 0.05, respectively). The smaller-dosage groups of IT
sufentanil required significantly more supplemental boluses of
propofol compared with the 20-microg group (67%, 53%, and 40% vs 6%, respectively, P < 0.05). However,
pruritus was significantly diminished in the smaller-dosage groups compared with the 20-microg group (55%, 60%, and 67% vs 100%, P < 0.05). The time to discharge was significantly shorter in the 15-microg group compared with the 20-microg group (84 +/- 40 min vs 126 +/- 48 min, P < 0.05). These results suggest that 15 microg of IT
sufentanil may be the optimal IT dose for patients undergoing extracorporeal
shock wave
lithotripsy.
IMPLICATIONS: Many
anesthetic techniques are used for extracorporeal
shock wave
lithotripsy (ESWL). We have previously shown that intrathecal
sufentanil was effective for ESWL, but was associated with a high incidence of
itching. We tested 60 patients in four spinal
sufentanil dose groups and found that doses of 15 and 17.5 microg provided the most effective
analgesia with the fewest side effects for ESWL, with only mild
itching.