Thoracic epidural bupivacaine-fentanyl anesthesia for percutaneous cholecystolithotomy in high-risk patients.

Background And Objectives: The efficacy of a thoracic epidural block was assessed in 12 high-risk patients scheduled for elective percutaneous cholecystolithotomy.

Methods: A thoracic epidural catheter was inserted at level T8-9. The amount of 0.5% bupivacaine to block two thoracic epidural segments was calculated, adapted to age, height, and epidural level, and administered with 50 micrograms fentanyl. Hemodynamic and respiratory variables and patients' pain and movement were assessed throughout the procedure.

Results: Anesthesia was obtained with a minimal dose of local anesthetic. All patients were satisfied with this method. Neither hemodynamic nor respiratory impairment were observed after epidural injection. However, vagal reactions reported in other studies occurred in two patients upon puncture of the gallbladder.

Conclusions: This minimally invasive anesthetic technique seems to be a good alternative for high-risk patients. However, careful monitoring of heart rate and blood pressure remains mandatory throughout the procedure.