Continuous spinal anaesthesia using a standard epidural set for extracorporeal shockwave lithotripsy

Area of Science:

• Anesthesiology
• Neurosurgery
• Urology

Background:

• Continuous spinal anaesthesia (CSA) allows for titrated anesthesia with local anesthetics (LA).
• Standard epidural sets can potentially be used for CSA.
• Extracorporeal shockwave lithotripsy (ESWL) often requires anesthesia for patient comfort.

Purpose of the Study:

• To evaluate the feasibility of using a standard epidural set for continuous spinal anaesthesia (CSA) during extracorporeal shockwave lithotripsy (ESWL).
• To assess the safety and efficacy of CSA in high-risk patients undergoing ESWL.

Main Methods:

• Retrospective review of 100 consecutive CSAs for ESWL.
• Lumbar CSA performed using a 20G epidural catheter via an 18G Tuohy needle.
• Anesthesia was either preplanned or followed inadvertent dural puncture; small LA boluses were administered to achieve desired sensory levels.

Main Results:

• Hyperbaric bupivacaine 0.1% was the primary anesthetic used (9.7 +/- 7.5 mg).
• Achieved sensory levels were T4-T8 with minimal hemodynamic changes.
• Post-dural puncture headache occurred in 2.5% of preplanned and 22.2% of inadvertent cases, with no neurological deficits detected.

Conclusions:

• Continuous spinal anaesthesia (CSA) with a standard epidural set and hyperbaric bupivacaine is feasible for ESWL, particularly in high-risk patients.
• Inadvertent dural puncture does not contraindicate the use of CSA in this setting.
• This technique offers a viable anesthetic option for ESWL, even in challenging patient populations.