Extracorporeal shock wave lithotripsy accompanies with pain. Is it worthwhile to perform intercostal nerve block for pain relief during ESWL?
Not ideal as we may require more than one session of ESWL to pulverize the stones. We prefer segmental thoracic epidural anesthesia through an epidural catheter.
Pain relief during ESWL can easily be achieved with iv analgesia and monitored anesthesia care. The risk-benefit ratio of regional anesthesia in this indication is not favourable, especially if large volumes of anesthetics are needed on multiple intercostal spaces.
No. The gain is minimal and the risk outweighs that gain. My practice uses general anesthesia with airway control via laryngeal mask airway. Patients awaken quickly and move themselves off the OR table.
Having said all that, the anesthetic requirements in ESWL vary greatly with the design of the shock wave generator. Generation 1 ESWL was quite painful. That improved progessively. Most devices used in the US today are well tolerated by patients.
Dr Tillman Hein has answered the question in a very erudite manner. For all the beauty of regional anaesthesia, general anaesthesia can also be a beautiful thing.
Not the best analgesia but certainly a working alternative.
Intercostal Blocks with Local Infiltration Anesthesia for Extracorporeal Shock Wave Lithotripsy. Malhotra V, Long C W, Meister M J. Anesth Analg. 1987 Jan;66(1):85-8.
Smiths textbook of Endourology 2011 Chapter 60. (Describes the block as easy to perform and well accepted by patients)
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