A prospective, observational study to assess the feasibility and safety of supine percutaneous nephrolithotomy under regional anesthesia for obese patients with a body mass index ≥30

Morsy, Samer Mahmoud; Abdelaziz, Islam Nasser; Rammah, Ahmed; Labana, Mahmoud Abdelaziz; Hussein, Hussein Aly

doi:10.4103/iju.iju_186_22

Cited by 2 publications

(2 citation statements)

References 14 publications

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“…Morsy et al, in his study on PCNL found good safety and feasibility of RA in 51 obese patients. 8 Gupta and Mahajan also reported suitability of RA in elderly, comorbid patients undergoing PCNL. 9 El-Husseiny et al, demonstrated that PCNL under SA or CSEA can be safely carried out in high-risk cases with ≥3 ASA class.…”

Section: Discussionmentioning

confidence: 95%

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

et al. 2023

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Background: Renal stone disease is prevalent worldwide. Percutaneous nephrolithotomy (PCNL) has become an important mode of treatment for large size renal stones. Various anesthetic techniques have described for performing PCNL, with each having its own merits and demerits. There is lacuna in evidence for the ideal mode of anesthesia with best results and least associated complications. Aims and Objectives: PCNL is a common procedure for renal stones. It can be performed under various anesthesia techniques. Selection of an appropriate anesthetic technique is essential for successful outcome. In this study, we compared three anesthesia techniques during PCNL and their outcomes. Materials and Methods: Retrospective and observational study involved all cases of PCNL performed from February 2022 to January 2023. Baseline clinical and anesthesia parameters were recorded. Three groups based on anesthesia method were made; Group A for general anesthesia (GA), B for spinal anesthesia (SA), and C for combined spinal epidural anesthesia (CSEA). Intraoperative variables including heart rate (HR), blood pressure, operation time, and analgesia adequacy were noted. Post-operative pain level, hospital stay, stone free rate (SFR), complications, patient, and surgeon satisfaction were recorded. Results: Seventy-two cases (56 Male and 16 Female) with a mean age of 36.2±15.9 years were included in the study. Age and body mass index were lower in Group A, while ASA status and comorbidities were comparable. Intraoperative HR and mean blood pressure were higher in Group A than in B and C (P=0.000, P=0.003). Hypotension was more frequent in Group B (24.1%, P=0.046). Operation time, hospital stay, transfusion rates, SFR, and overall patient satisfaction were similar. Group A patients experienced more post-procedure pain (Visual analogue scale 4.1 vs. 2.2 vs. 2.1; P=0.001). Nausea-vomiting and shivering episodes were also higher in Group A (P=0.033, P=0.021). Anesthetic effect weaned-off in 6 patients of SA. Post-operative headache was higher but non-significant in Group B and C (P=0.621). Conclusion: CSEA appears a superior alternative to both SA and GA, with additional adequate post-operative comfort.

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Section: Discussionmentioning

confidence: 95%

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

et al. 2023

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“…Morsy et al [ 21 ] investigated the feasibility and safety of supine PCNL under RA in obese patients. They concluded that RA is feasible and safe in these patients with satisfactory stone-free rates and minimal postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Performing Supine Percutaneous Nephrolithotomy for Solitary Renal Pelvic Stones (1.5-3 cm) Under Spinal Anaesthesia: A Single-Centre Study

Gupta¹,

Khan²,

Sunana³

et al. 2023

Cureus

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Introduction Percutaneous nephrolithotomy (PCNL) procedure has evolved over the years and one such evolution has been the introduction of supine PCNL by Valdivia in 1987. This approach offers the added advantage of safe access in patients with compromised cardiovascular and pulmonary function. General anesthesia is the preferred anesthetic technique for PCNL. However, in the last decade, there has been an increase in the usage of regional anesthesia for this procedure. We share our experience of supine PCNL for solitary renal pelvic stones under regional anesthesia. Aim and objective To assess the feasibility, safety, and efficacy of supine PCNL for solitary renal pelvic stones sized 1.5 to 3 cm under spinal anesthesia. Material and methods This was a retrospective record review of 35 patients (21 male) who underwent supine PCNL under regional anesthesia between January 2022 till December 2022 at our institute. All patients had a solitary renal pelvic calculus sized 1.5-3 cm. Intraoperative and postoperative data were analyzed. Results The mean age of patients was 38.5 ± 15 years. The postoperative pain visual analog scale (VAS) score was <5 in 31 (89%) and >5 in 4 (11%) patients. The mean hospital stay was 3.33 ± 0.88 days. Mean fall in hemoglobin level was 0.49 ± 0.43 mg/dL. Postoperatively, mild hematuria occurred in three patients (8.5%) and fever occurred in two (5.7%) patients. There was no injury to adjacent organs in this series. Blood transfusion was required only in one patient. Complete stone clearance was achieved in all patients. Conclusion In experienced hands, supine PCNL under regional anesthesia is a feasible, safe, and effective approach with minimal morbidity.

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A prospective, observational study to assess the feasibility and safety of supine percutaneous nephrolithotomy under regional anesthesia for obese patients with a body mass index ≥30

Cited by 2 publications

References 14 publications

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

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

Feasibility of Performing Supine Percutaneous Nephrolithotomy for Solitary Renal Pelvic Stones (1.5-3 cm) Under Spinal Anaesthesia: A Single-Centre Study

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