title: Epidural anesthesia is effective for extracorporeal shock wave lithotripsy of pancreatic and biliary calculi.
abstract: OBJECTIVE
  To evaluate the efficacy of thoracic epidural analgesia for extracorporeal shock wave lithotripsy (ESWL).
  
  
  METHODS
  ESWL is an effective, non-invasive technique for the treatment of difficult pancreatic and large bile duct calculi. The procedure is often painful and requires large doses of analgesics. Many different anesthetic techniques have been used. Patients with either large bile duct calculi or pancreatic duct calculi which could not be extracted by routine endoscopic methods were selected. Thoracic epidural anesthesia (TEA) was routinely used in all the subjects unless contraindicated. Bupivacaine 0.25% with or without clonidine was used to block the segments D6 to D12. The dose was calculated depending on the age, height and weight of the patient. It was usually 1-2 mL per segment blocked.
  
  
  RESULTS
  Ninety eight percent of the 1509 patients underwent ESWL under TEA. The subjects selected were within American Society of Anesthesiologists grade I to III. ESWL using EA permitted successful elimination of bile duct or pancreatic calculi with minimal morbidity. The procedure time was shorter in patients with TEA than in those who underwent ESWL under total intravenous anesthesia.
  
  
  CONCLUSIONS
  Almost all patients undergoing ESWL with EA had effective blocks with a single catheter insertion and local anesthetic injection.
authors.affiliation: Santosh Darisetty, Rama Kotla, Department of Anesthesiology, Asian Institute of Gastroenterology, Hyderabad 500082, India.
authors.forename: Santosh
authors.initials: S
authors.lastname: Darisetty
authors.forename: Manu
authors.initials: M
authors.lastname: Tandan
authors.forename: Duvvuru Nageshwar
authors.initials: DN
authors.lastname: Reddy
authors.forename: Rama
authors.initials: R
authors.lastname: Kotla
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gupta
authors.forename: Mohan
authors.initials: M
authors.lastname: Ramchandani
authors.forename: Sandeep
authors.initials: S
authors.lastname: Lakhtakia
authors.forename: Guduru Venkat
authors.initials: GV
authors.lastname: Rao
authors.forename: Rupa
authors.initials: R
authors.lastname: Banerjee