The Journal of stone disease
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Comparative Study
Evaluation of patient controlled sedation and analgesia for ESWL.
This study was designed to evaluate the quality of sedation/analgesia and patient cooperation provided by Patient Controlled Sedation & Analgesia (PCSA) using propofol and fentanyl (Group II) when compared with anesthetist administered propofol/fentanyl (Group I) in 32 ASA I & II patients undergoing ESWL of renal or ureteric stones. Demographics of the patients and the duration of ESWL were similar in both groups. ⋯ PCSA provided a marginally higher degree of patient and surgeon satisfaction scores as compared to anesthetist administered propofol/fentanyl. Quick recovery was more consistent in the PCSA group as compared to group I patients.
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Comparative Study
The use of transcutaneous electrical nerve stimulation during the biliary lithotripsy procedure.
Transcutaneous electrical nerve stimulation (TENS) has been suggested as a means to reduce the amount of intravenous analgesia/sedation in patients undergoing extracorporeal shock wave lithotripsy (ESWL). A retrospective analysis of 79 ESWL procedures on 73 consecutive unselected patients was done in an attempt to determine the effectiveness of TENS in reducing the amount of intravenous fentanyl citrate and/or midazolam HCl needed to control pain and anxiety during the ESWL procedure. The study was divided into two parts: (1) all patients receiving TENS (n = 44) versus a non-TENS group (n = 35), and (2) comparison of the early (n = 22) and late non-TENS (n = 22) groups against each other; separately the late non-TENS group was compared to the entire TENS group. ⋯ A gender difference was noted with a significant reduction in the dose of fentanyl citrate only in female patients receiving TENS (45.4%). Likewise, there was a significant reduction in the dose of midazolam HCl only in males who had TENS (38.9%). The data suggests that TENS may be a useful addition to reduce the amount of sedation and analgesia during ESWL.