A Comparative Study of Epidural Anesthesia with Dexmedetomidine Infusion versus General Anesthesia for Percutaneous Nephrolithotomy

Abstract

Background: There has been considerable debate regarding the ideal anaesthetic technique for Percutaneous Nephrolithotomy (PCNL). PCNL is usually performed under general anaesthesia (GA) in prone position. The prone position under GA is associated with various complications. To address these complications, our study was carried out to determine whether epidural anaesthesia [EA] with dexmedetomidine sedation can be a better alternative to GA for PCNL. Aims and Objectives: To compare the efficacy and feasibility of performing PCNL under EA in combination with dexmedetomidine infusion. Methods and Material: Out of 225 patients observed in this study, 115 patients (group A) underwent PCNL under EA with dexmedetomidine infusion and 110 patients (group B) underwent PCNL under GA. Results: Mean time to the first dose of rescue analgesia was significantly increased in Epidural group (328.17 ± 63.74) compared to GA group (72.09 min, p < .0001) and the mean Visual analog scale [VAS] scores were significantly lower in epidural compared to GA group at different time intervals during the first 24 h after surgery (p<0.05). Patients in epidural group had significantly less post-operative nausea, vomiting (6.1 % vs 13.6 %), and significantly less shivering (12.2% vs 33.6%). Mean patient satisfaction score in epidural group was significantly higher (8.75 ± 1.29 vs 8.14 ± 1.39, p=0.001); however, the mean surgeon satisfaction score was comparable among the two groups (8.76 ± 1.39 in Group A and 8.61 ± 1.35 in Group B, p=0.421). Conclusions: Our study shows that EA is an equally effective alternative to GA for PCNL, with more patient satisfaction, less postoperative pain, early ambulation and postoperative recovery, less systemic analgesic requirements and less adverse effects.

Finding the optimal anesthetic technique during PCNL for renal stone disease: A comparison of general, spinal, and combined spinal epidural anesthesia

“…11,12 Baseline MBP was higher in the SA and CSEA groups, likely due to the higher proportion of elderly and obese patients in these groups. Despite this, a fall in MBP was observed in these groups after anesthesia 11,14 This was contrary to our observations.…”

“…Similar findings are reported in the literature. 7,11,15 Intraoperative hypotension episodes were higher in the SA and CSEA groups in our study, which was in accordance with the findings of Kamal et al, 21 and Solakhan et al, 7 However, Turki et al, 11 and Kumawat et al, 14 did not find this difference. The reason for this discrepancy may be attributed to the preloading of crystalloid or the use of vasopressor agents in different studies.…”

“…16,23 The stone-free rate was found to be equivalent among the groups in our study, a finding that was further supported by numerous other reports in the literature. 7,15,17 Kuzgunbay et al, 24 Turki et al, 11 and Shah et al, 25 reported a higher patient satisfaction level in the RA group, while Moawad et al, showed better overall patient satisfaction in the GA group. 26 We observed a similar level of patient satisfaction among the study groups, which may be attributed to the multiple factors that affect satisfaction levels.…”