lithotripsy

[Mman]

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anybody doing any sort of regional analgesia for these?

Not asking about MAC, GA, regional choices for the procedure. We do plenty of the cases, but a former colleague of mine emailed me asking if we were doing anything for pure analgesia after the fact. Apparently their hospital was approaching them asking about it and I am have no personal experience. I hesitate to guess what you'd even use?? Anybody doing ESPs or QLs???

I'm leaning towards saying there is no good option and not worth the hassle, but am open to suggestions if people are currently doing anything in this regard.

 

[GassYous]

I don't but a ql block should work. I think some toradol should be fine.

 

[Planktonmd]

Do a short lasting spinal with either Lidocaine or chloroprocaine and add a small dose of fentanyl like 12.5 mcg... but discharge from PACU is tough to predict.

 

[coffeebythelake]

Maybe thatr hospital need newer lithotripsy machines

 

[deleted162650]

Midol

 

[FiO2@21]

Doesn't seem worth it. For me they're already somewhat satisfying since you can run them so light. They generally wake up very fast and pretty happy, completely conversational and comfortable by the time you're transporting.

Already hits the the goals of an ideal anesthetic, would suspect motives of anyone saying a block would add significant value.

 

[Arch Guillotti]

prop sux tube next

 

[Hork Bajir]

Some ppl at my residency were doing PVB. Seemed like overkill to me (especially when residents were doing the block, which would take 45+ minutes)

 

[GassYous]

Some ppl at my residency were doing PVB. Seemed like overkill to me (especially when residents were doing the block, which would take 45+ minutes)

wtf? For a 15 minute case?

 

[Arch Guillotti]

wtf? For a 15 minute case?

Our guys take about an hour.

 

[DocMcCoy]

Our guys take about an hour.

Our litho max dose 3000 shocks. Takes right at about an hour procedure time. Still, prop sux tube or LMA. easy peasy.

 

[Ezekiel2517]

Would not be feasible where I am. Not uncommon to have 10-15 of these cases in a day. I just go w LMA's.

 

[DrOwnage]

I understand there's a push for utility of regional. But for lithotripsy? Come on

 

[AdmiralChz]

LMA all day. You don’t need to make EVERY case regional.

Side note, I am not certain QL would cover the visceral surface of the kidney anyway. Paravertebral clearly isn’t worth the risk, and definitely not the time.

 

[coffeebythelake]

We do MAC for 95% of our lithotripsy cases. Not even heavy MACs. Not much postop pain.

 

[secretasianman]

Solution looking for a problem?

 

[Simba1711]

I do light sedation for my lithotripsys too

 

[Mman]

Solution looking for a problem?

I guess, not sure. I have no experience with it and was wondering if I was totally of the loop. We don't do many but just do some light sedation for the ones we do. Not sure why they were having significant pain issues postop, poor patient selection??

 

[Zekchar]

Solution looking for a problem?

This. These cases should be either Propofol drips or LMAs. Wash, rinse, repeat. Doing blocks for these procedures is likely a form of medical billing fraud, meant to run up the compensation. I mean I "COULD" place a cordis, a-line, spinal, and TAP block for a lap appy, but that would be fraudulent as well.

 

[deleted875186]

How about some urojet

 

[AdmiralChz]

I guess, not sure. I have no experience with it and was wondering if I was totally of the loop. We don't do many but just do some light sedation for the ones we do. Not sure why they were having significant pain issues postop, poor patient selection??

Shockwave lithotripsy breaks stones up, but patients do still have to pass the fragments. Can be painful if there’s larger pieces going through.

 

[Hoya11]

Shockwave lithotripsy breaks stones up, but patients do still have to pass the fragments. Can be painful if there’s larger pieces going through.

ive unfortunately had the procedure done 5 times..

NO pain at any point after that toradol/nsaids couldnt cover completely, block would be ridiculous

 

[coffeebythelake]

ive unfortunately had the procedure done 5 times..

NO pain at any point after that toradol/nsaids couldnt cover completely, block would be ridiculous

New lithotripsy machine? Did u get MAC?

 

[Hoya11]

New lithotripsy machine? Did u get MAC?

I did get MAC. Seemed like the same machine they have everywhere else..
I typically give propofol, versed, 100 fent and toradol with some generous IVF and people do great

 

[GassYous]

I did get MAC. Seemed like the same machine they have everywhere else..
I typically give propofol, versed, 100 fent and toradol with some generous IVF and people do great

Pretty much what I do with some decadron, zofran and an lma

 

[GASPER20]

If I had to do a block it would be QL for visceral coverage.