Arroyo C S, Michaels E K, Laurito C E, Schreibman M L, Kandel G
Department of Urology, University of Illinois College of Medicine, Chicago, USA.
J Endourol. 1995 Feb;9(1):41-3. doi: 10.1089/end.1995.9.41.
The painful stimuli produced by a new generation of electrohydraulic/electromagnetic lithotripters are such that continuous infusion analgesia rather than general or regional anesthesia is appropriate. We describe our experience with continuous alfentanil infusion supplemented with intravenous bolus midazolam in caring for patients treated with an unmodified Medstone STS 1050 lithotripter. Ninety consecutive treatments using this technique averaged 63 minutes, compared with 69 minutes for 14 treatments done with general anesthesia and 88 minutes for 58 treatments done with epidural anesthesia. The stone burden, kilovoltage, and number of shocks were similar for the three groups, as was the immediate stone fragmentation rate. Only 2 of 90 patients received inadequate analgesia with the intravenous technique and required the induction of general anesthesia. Continuous-infusion analgesia appears sufficient to blunt the stimulus provided by the unmodified spark-gap lithotripters still in common use.
新一代电液压/电磁碎石机产生的疼痛刺激使得连续输注镇痛而非全身或区域麻醉更为合适。我们描述了在护理使用未改良的Medstone STS 1050碎石机治疗的患者时，采用持续输注阿芬太尼并辅以静脉推注咪达唑仑的经验。使用该技术连续进行的90次治疗平均时长为63分钟，相比之下，14次全身麻醉治疗平均时长为69分钟，58次硬膜外麻醉治疗平均时长为88分钟。三组的结石负荷、千伏数和冲击次数相似，即时结石破碎率也相似。90例患者中只有2例采用静脉技术镇痛不足，需要诱导全身麻醉。持续输注镇痛似乎足以减轻仍在普遍使用的未改良火花隙碎石机所产生的刺激。
