DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20221810

Spinal anesthesia versus general anesthesia for percutaneous nephrolithotomy surgeries - a prospective study

Mahesh Eddula, Vasant P. Patil

Abstract


Background: Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgery for extracting renal and urinary stones, and a choice modality in large, multiple, and stag-horn stones. Anaesthesia for PCNL can be general or regional. Despite good results of PNCL with general anaesthesia, it may cause atelectasis, drug reactions, nausea, and vomiting. General anaesthesia (GA) has its limitations in the form of poor postoperative pain control, greater incidence of nausea and vomiting, prolonged recovery stays and prolonged hospitalizations.

Methods: The study was performed in a tertiary care centre. A prospective, randomised study including 60 patients divided into 2 groups. Data collection tools included study proforma, numerical rating scale (NRS) scores and visual analog scale (VAS) scores. Data analysed using science and statistical packaged (SPSS) version 21, independent t tests and z-test for proportion.

Results: The demographic data when statistically analysed showed no statistically significant differences between the groups. Haemoglobin percentage (Hb%) was significantly lower in GA group. Spinal anaesthesia (SA) group showed lower VAS and NRS scores hence lower requirement of pain relief and antiemetics. The post-operative complications were insignificant.

Conclusions: We concluded that SA is safe and effective method as an alternative method for PCNL surgeries.

 


Keywords


Percutaneous nephrolithotomy, Spinal anaesthesia, General anaesthesia

Full Text:

PDF

References


Stening SG, Bourne S. Supracostal percutaneous nephrolithotomy for upper pole caliceal calculi. J Endourol. 1998;12(4):359-62.

Lojanapiwat B, Prasopsuk S. Upper-pole access for percutaneous nephrolithotomy: comparison of supracostal and infracostal approaches. J Endourol. 2006;20(7):491-4.

Jun-Ou J, Lojanapiwat B. Supracostal access: does it affect tubeless percutaneous nephrolithotomy efficacy and safety? Int Braz J Urol. 2010;36(2):171-6.

Kuzgunbay B, Turunc T, Akin S, Ergenoglu P, Aribogan A, Ozkardes H. Percutaneous nephrolithotomy under general versus combined spinalepidural anesthesia. J Endourol. 2009;23(11):1835-8.

Karacalar S, Bilen CY, Sarihasan B, Sarikaya S. Spinal-epidural anesthesia versus general anesthesia in the management of percutaneous nephrolithotripsy. J Endourol. 2009;23(10):1591-7.

Wong MY. Evolving technique of percutaneous nephrolithotomy in a developing country: Singapore General Hospital experience. J Endourol. 1998;12(5):397-401.

Singh I, Kumar A, Kumar P. "Ambulatory PCNL" (tubeless PCNL under regional anesthesia) - a preliminary report of 10 cases. Int Urol Nephrol. 2005;37(1):35-7.

El-Husseiny T, Moraitis K, Maan Z, Papatsoris A, Saunders P, Golden B, et al. Percutaneous endourologic procedures in high-risk patients in the lateral decubitus position under regional anesthesia. J Endourol. 2009;23:1603-6.

Mehrabi S, Karimzadeh Shirazi K. Results and complications of spinal anesthesia in percutaneous nephrolithotomy. Urol J. 2010;7:22-5.

Aravantinos E, Karatzas A, Gravas S, Tzortzis V, Melekos M. Feasibility of percutaneous nephrolithotomy under assisted local anaesthesia: a prospective study on selected patients with upper urinary tract obstruction. Eur Urol. 2007;51:224-7.

Rozentsveig V, Neulander EZ, Roussabrov E, Schwartz A, Lismer L, Gurevich B, et al. Anesthetic considerations during percutaneous nephrolithotomy. J Clin Anesth. 2007;19:351-5.

Trivedi NS, Robalino J, Shevde K. Interpleural block: a new technique for regional anaesthesia during percutaneous nephrostomy and nephrolithotomy. Can J Anaesth. 1990;37:479-81.

Corbel L, Guille F, Cipolla B, Staerman F, Leveque JM, Lobel B. Percutaneous surgery for lithiasis: results and perspectives. Prog Urol. 1993;3:658-65.

Salonia A, Suardi N, Crescenti A, Colombo R, Rigatti P, Montorsi F. General versus spinal anesthesia with different forms of sedation in patients undergoing radical retropubic prostatectomy: results of a prospective, randomized study. Int J Urol. 2006; 13: 1185-90.

Maurer SG, Chen AL, Hiebert R, Pereira GC, Di Cesare PE. Comparison of outcomes of using spinal versus general anesthesia in total hip arthroplasty. Am J Orthop (Belle Mead NJ). 2007;36:E101-6.

Movasseghi G, Hassani V, Mohaghegh MR, Safaeian R, Safari S, Zamani MM, Nabizadeh R. Comparison between spinal and general anesthesia in percutaneous nephrolithotomy. Anesth Pain Med. 2013;4(1):e13871.

Covino BG. Rationale for spinal anesthesia. Int Anesthesiol Clin. 1989;27(1):8-12.

Tangpaitoon T, Nisoog C, Lojanapiwat B. Compared the efficacy and safety of regional epidural anaesthesia and general anaesthesia in patients who underwent PCNL. Int Braz J Urol. 2012;38(4):504-11.

Andreoni C, Olweny EO, Portis AJ, Sundaram CP, Monk T, Clayman RV. Effect of single-dose subarachnoid spinal anesthesia on pain and recovery after unilateral percutaneous nephrolithotomy. J Endourol. 2002;16(10):721-5.