A Prospective Randomized Study Comparing Percutaneous Nephrolithotomy under Combined Spinal-Epidural Anesthesia with Percutaneous Nephrolithotomy under General Anesthesia

Abstract

Objective: A prospective randomized study was executed to compare the surgical parameters and stone clearance in patients who underwent percutaneous nephrolithotomy (PNL) under combined spinal-epidural anesthesia (CSEA) versus those who underwent PNL under general anesthesia (GA). Methods: Between January 2008 to December 2009, 64 patients with renal calculi were randomized into 2 groups and evaluated for the purpose of this study. Group 1 consisted of patients who underwent PNL under CSEA and Group 2 consisted of patients who underwent PNL under GA. The operative time, stone clearance rate, visual pain analog score, mean analgesic dose and mean hospital stay were compared amongst other parameters. Results: The difference between visual pain analog score after the operation and the dose of analgesic requirement was significant on statistical analysis between both groups. Conclusion: PNL under CSEA is as effective and safe as PNL under GA. Patients who undergo PNL under CESA require lesser analgesic dose and have a shorter hospital stay.

Retrograde Intrarenal Surgery with Combined Spinal-Epidural vs General Anesthesia: A Prospective Randomized Controlled Trial

“…Several studies report lower levels of postoperative pain for PCNL procedures undertaken with spinal or epidural anesthesia compared with GA. [9][10][11] However, in RIRS, pain assessed at multiple postoperative time points was not significantly different in patients who had CSEA compared with patients who had GA. The reason may be explained by the minimally invasive nature of the RIRS procedure, which itself is associated with slight postoperative pain.…”

A Comparison of Efficacy of Segmental Epidural Block versus Spinal Anaesthesia for Percutaneous Nephrolithotomy

“…General Anaesthesia prone to complicate in terms of vascular, pulmonary and neurological issues, especially during changing patient's position from lithotomy to prone [7]. Spinal Anaesthesia is usually associated with hypotension during changing into prone position [8,9].…”

A comparative study of combined spinal epidural anaesthesia and general anaesthesia in patients undergoing percutaneous nephrolithotomy

“…11 In study done by Singh et al in, hemodynamic instability was observed in 3 patients in the CSE group and 2 patients in the GA group, which was insignificant on statistical analysis. 18 Mehrabi et al in 2011 evaluated 160 consecutive patients who underwent PCNL under SA. 19 They reported hypotension in 18 patients, 3 to 10 minutes after RA that was controlled by injecting 10 mg ephedrine intravenously.…”

“…11,18,25,26,28 Karacalar Serap et al studied 180 patients undergoing PCNL, concluded that CSE gave greater patient satisfaction, shorter times for PACU and home readiness, and less postoperative pain (p = 0.001). 20 Elbeally et al conducted a study on 57 patients undergoing PCNL in GA, epidural anaesthesia (EA) and paravertebral block (P).…”