[Extracorporeal shock-wave therapy (ESWT) for pseudoarthrosis. A new indication for regional anesthesia]

Extracorporeal shock-wave therapy for the treatment of pseudarthrosis is a new indication for anaesthesia. In a clinical trial of 65 treatments in 53 patients, the anaesthetic procedure is shown. Regional anaesthesia, mainly plexus blocks of the upper and lower extremities, was performed in nearly all cases. The various localisations of the pseudarthroses and the types of anaesthetic techniques used are shown in Table 1. In all, we performed 9 epidural blocks, 2 spinal blocks, 29 axillary blocks, 3 supraclavicular perivascular blocks (Winnie), 1 psoas compartment block, and 20 sciatic/femoral 3-in-1 blocks. The shock waves used for this therapy are several times stronger than those used for nephrolithotripsy. Furthermore, the shockwaves are focused on bone and periosteum, which is abundantly innervated. Therefore, in contrast to nephro-lithotripsy with second-generation lithotripters, anaesthesia must be performed for this therapy. We chose regional anaesthesia for several reasons: the procedures are located in the arms or legs, which can readily be anaesthetised by regional blocks. The duration of treatment ranged up to several hours. By using regional anaesthesia, we were able to avoid unnecessary exposure to general anaesthetics. Finally, most of the patients wanted to stay awake during the new treatment and therefore opted for regional techniques. A typical set-up for the treatment is shown in Fig 1. In 67% of the patients fracture healing was significantly improved by the new therapy. Acceptance of therapy and anaesthesia by the patients was very good.