Patient Controlled Anesthesia in Extracorporeal Shock Wave Lithotripsy for Urolithiasis

自控式麻醉在體外震波碎石的應用

王碩盟(So-Mong Wang) ； 徐慧興(Hueih-Shing Hsu) ； 許正中(Ching-Chung Shu) ； 賴明坤(Ming-Kuen Lai)

《中華民國泌尿科醫學會雜誌》 13卷1期 (2002/03) Pp. 20-24

https://doi.org/10.7024/JUAROC.200203.0020

摘要

研究目的：新一代體外震波碎石引進台灣已有多年，新的碎石機不需泡水且造成的痛也減輕許多，對震波過程的止痛已有多種麻醉方法被嘗試過。使用病人自控式機器給予止痛藥，由國外的報告可知在震波碎石止痛的效果顯著，本篇試著對台灣人使用病人自控式機器給予止痛藥來測試其使用於體外震波碎石的可行性。
材料及方法：自從1997年3月至7月，71位門診結石病人分成兩組，其中一組由麻醉科人員應病人要求使用fentanyl注射，而另一組則使用病人自控式機器來給予fentanyl。兩組的結石大小，分佈位置，最大碎石能量、時間及次數，疼痛評分予以紀錄。
結果：兩組所需麻藥具有意義區分，其平均值±標準差分別為19.0±20.0μg.及71.7±29.5μg.（p=0.00）。麻醉造成的副作用在PCA組也較少。
結論：病人自控式機器給予止痛藥減少麻醉藥需求，其副作用也相對減少，對實施門診體外震波碎石的病人提供了一個安全及可行的麻醉方法。雖然每組自控式機器不便宜，但在考慮病人舒適性及安全性上，則仍為一可行的選擇。

關鍵字

病人自控式止痛機器 ； 體外震波碎石 ； 泌尿道結石

並列摘要

OBJECTIVE: New generation lithotriptors have been introduced into Taiwan for years. These lithotriptors offer an immersion-free treatment and a decrease in shock wave induced pain. Among several different analgesic methods used to overcome the pain experienced during extracorporeal shock wave lithotripsy (ESWL), patient controlled analgesia (PCA) was reported in foreign literature to have effect in pain relief. We test the feasibility of PCA in ESWL in Taiwan.
MATERIALS AND METHODS: From March to July 1999, 71 consecutive patients with renal or ureteric stones were enrolled into two groups to have fentanyl infused by PCA or by anesthesiologist. The dose of fentanyl, stone size, location, maximum energy level achieved, number of shock waves given, duration of procedure and pain scores were recorded as the parameters to evaluate the difference between two groups.
RESULTS: The fentanyl needed in PCA group and non-PCA group were 19.0±20.0μg. versus 71.7±29.5μg.,(p=0.00).The side effect of fentanyl was lower in PCA group.
CONCLUSIONS: PCA decreases narcotic requirement and hence its adverse effect. These advantages favor an outpatient procedure and can be used to quantify the amount of analgesic requirement during lithotripsy. In consideration of safety and comfort, PCA may be an alternative choice of pain control for ESWL.

並列關鍵字

patient controlled anesthesia ； extracorporeal shock wave lithotripsy ； fentanyl ； urinary calculi