Comparison of thoracic segmental spinal anaesthesia and lumbar spinal anaesthesia for percutaneous nephrolithotomy

Abstract

Background: This study aimed to compare the feasibility and safety of low thoracic segmental spinal anesthesia (TSSA) and conventional lumbar spinal anesthesia (LSA) in percutaneous nephrolithotomy (PCNL). Methods: Sixty adult patients undergoing elective PCNL were randomly assigned to two groups: T (TSSA) and L (LSA). Group T received TSSA (isobaric ropivacaine 0.75% 2.5 ml with dexmedetomidine 6mcg) at T10-T12, while Group L received LSA (hyperbaric ropivacaine 0.75% 4 ml with dexmedetomidine 6mcg) at L2-L4. Primary objectives included assessing hemodynamic changes, block onset, and duration, and adverse effects. Secondary objectives were time to rescue analgesia, patient, and surgeon satisfaction. Data was analyzed using SPSS. Results: All patients underwent surgery successfully under neuraxial anesthesia. Group T exhibited more stable hemodynamics with a significantly lower hypotension incidence compared to Group L (3.33% vs. 26.66%, p=0.03). Onset of sensory and motor block was quicker in the TSSA group (p<0.001). Sensory block levels were T6 for both groups, but TSSA affected levels L2 and L3, while LSA impacted all segments below T6. No neurological complications occurred, particularly in Group T, which had higher satisfaction scores from surgeons and patients. Conclusions: TSSA is a safe and effective option for PCNL, providing better hemodynamic stability and reducing intra-operative hypotension compared to conventional LSA.