A Comparison of Epidural Anesthesia without Motor Block Versus General Anesthesia for Percutaneous Nephrolithotomy

Abstract

What's known on the subject? and What does the study add? Amaç: Çalışma, motor bloksuz epidural anestezi (EA) altında perkütan nefrolitotomi (PNL) uygulanan hastalara karşı genel anestezi (GA) uygulanan hastaların operasyon parametrelerini ve taş temizlenmesini karşılaştırmak için yürütülmüştür. Gereç ve Yöntem: Ocak 2014 ile Eylül 2014 tarihleri arasında kliniğimizde PNL uygulanan iki grup geriye dönük olarak incelendi. Grup 1, motor bloksuz EA uygulanan ardışık 69 hasta ve grup 2 de GA altında PNL uygulanan ardışık 69 hastadan oluştu. İki grup arasında hastaların genel özellikleri, taş özellikleri, cerrahi parametreler, ameliyat süresi, ameliyat odasındaki süre, postoperatif analjezik gereksinimleri, komplikasyonlar, taş temizleme oranı ve ortalama hastanede kalış süreleri karşılaştırıldı. Bulgular: İki grup arasında yaş, cinsiyet, taş boyutu ve daha önce yapılan cerrahi açısından benzerlik vardı. Her iki grupta da operasyon süresi, erişim yeri, ortalama erişim sayısı, ameliyat sonrası ateş, drenaj, ortalama hemoglobin düşmesi, taşsızlık oranı, nefrostomi süresi ve hastanede yatış süresi benzerdi. Ameliyat odasında geçen süre, kan transfüzyon oranı ve EA grubundaki postoperatif analjezik gereksinimleri GA grubundakilere göre anlamlı derecede düşüktü. Objective: The study carried out to compare the operative parameters and stone clearance in patients who underwent percutaneous nephrolithotomy (PNL) under epidural anesthesia (EA) without motor block versus those who underwent PNL under general anesthesia (GA). Materials and Methods: We retrospectively reviewed 2 groups of patients who underwent PNL at our institute between January 2014 and September 2014. Group 1 consisted of 69 consecutive patients who underwent PNL under EA without motor block and group 2 consisted of 69 consecutive patients who underwent PNL under GA. Patients general characteristics, stone features, surgical parameters, duration of surgery, time spent in the operating room, postoperative analgesic requirements, complications, stone clearance rate and mean length of hospital stay were compared between the 2 groups. Results: The two groups were similar in terms of mean age, gender, stone size and previous surgery. Operative time, access site, mean access number, postoperative fever, drainage, mean hemoglobin drop, stone-free rate, duration of nephrostomy tube and length of hospitalization were also similar between the groups. The time spent in the operating room, blood transfusion rate and postoperative analgesic requirements in EA group were significantly lower than those in GA group. Conclusion: PNL under EA without motor block is as effective and safe as PNL under GA and it offers some advantages as with lower parenteral analgesic requirements, lower transfusion rates and lesser usage of operation room.

The effect of anesthesia type on the outcomes of percutaneous nephrolithotomy in elderly males

“…(2018) reported a similar situation in their studies and that patients who underwent PNL under CSEA spent less time in the operating room. The authors attributed this observation to the lack of recovery time in CSEA unlike GA [ 25 ]. In the current study, we found that duration time in the operating room was significantly shorter in the Group CSEA than the Group GA in elderly male patients, similar to the findings of the younger population (<0.001).…”

“…(2013) showed that the need for opioid analgesia on the postoperative first day after PNL was less in Group CSEA compared to Group GA [ 26 ]. Singh and Oner also noted in their studies that groups who underwent RA needed fewer analgesic agents than GA in the postoperative period [ 23 , 25 ]. In accordance with the previous results, the postoperative analgesic requirement was significantly lower in the Group CSEA in our study ( p < 0.001).…”