Safety and Efficacy of Spinal Anaesthesia in Percutaneous Nephrolithotomy

  • Rajiv Shah Department of Urosurgery, College of Medical Sciences, Bharatpur, Nepal
  • Ajaya Singh Thapa Department of Anaesthesia, College of Medical Sciences, Bharatpur, Nepal
  • Nirmal Lamichhane Department of Urosurgery, College of Medical Sciences, Bharatpur, Nepal
  • Sudeep Raj KC Department of Urosurgery, College of Medical Sciences, Bharatpur, Nepal
Keywords: general anaesthesia; percutaneous nephrolithotomy; spinal anaesthesia.

Abstract

Introduction: Renal stone is one of the common entities occurring in our population. There are different treatment modalities of stones; out of those percutaneous nephrolithotomy is one of the most popular and effective for the renal and upper tract stones. This study is based to compare the safety and efficacy of spinal anaesthesia and general anaesthesia in PCNL.
Methods: In a randomized prospective study 60 patients were divided in two groups; group 1 (n=30) underwent PCNL in general anaesthesia and group 2 (n=30) underwent PCNL in spinal anaesthesia in prone position with the conventional technique. Demographic, operative data, post operative complications, patients’ satisfaction rate and follow up complications were recorded and analyzed between two groups.
Results: Mean age in group 1 was 39.10±12.45years and 36.10±14.18 in group 2 (P=0.100). Mean stone size in group 1 was 3.75±1.27cm and 3.23±1.36cm in group 2 (P=0.129).Similarly the operative time was 89.10 ± 49.38 min and 62.53±35.91 min in group 1 and group 2 respectively (P=0.042). There was no significant difference between the complications regarding the anaesthesia. Post operative nausea and vomiting were significantly higher in group 1 and headache in group 2 (p=<0.001). Overall patient satisfaction rate was higher in group 2 then in group 1 (p=0.01). Hospital stay in group 1 was 5.27±1.87 days and 4.53±1.88 days in group 2 (p = 0.07). Stone success rate was similar in each group (p =0.50).
Conclusions: Spinal anaesthesia is a safe and effective method in performing PCNL.

Keywords: general anaesthesia; percutaneous nephrolithotomy; spinal anaesthesia. | PubMed

References

1. Aravantinos E, Karatzas A, Gravas S, Tzortzis V, Melekos M. Feasibility of percutaneous nephrolithotomy under assisted local anaesthesia: a prospective study on selected patients with upper urinary tract obstruction. Eur Urol. 2007;51(1):224-7.
2. Elbealy M, Rashwan D, Kassim SA, Abbas S. A comparision of the effects of epidural anaesthesia,lumbar paravertebral block and general anaesthsia in percutaneous nephrolihotomy. J Med Sci. 2008;8(2):170-6.
3. Tangpaitoon T, Nisoog C, Lojanapiwat B. Eficacy and safety of percutaneous nephrolithotomy (PCNL): a prospective and randomised study comparing regional epidural anaesthesia. Int Braz J Urol. 2012;38(4):504-11.
4. Prakash R, Kushwaha B, Shasibhusan, Bhatia V, Chandra G, Singh B. A comparative study of bupivacaine 0.25% alone and with fentanyl or dexmedetomidine for percutaneous nephrolithotomy (PCNL) under epidural anaesthesia. Indian J Sci Res. 2014;5(1):39-46.
5. Attari M, Mirhosseini S, Honarmand A, Safavi M. Spinal anaesthesia versus genearal anaesthesia for elective lumbar spine surgery:a randomised clinical trial. J Res Med Sci. 2011;16(4):524-9.
6. Singh V, Sinha R, Sankhwar S, Malik A. A prospective randomised study comparing percutaneous nephrolithotomy under combined spinal-epidural anaesthesia with percutaneous nephrolithotomy under general anaesthesia. Urol Int. 2011;87:293-8.
7. Kim SS, Jeong WL, Yu JH, Sung LH, Chung JY, Noh CH. Percutaneous nephrolithotomy: comparision of the efficacies and feasibilities of regional and general aneshesia. Korean J Urol. 2013;54:846-50.
8. 8.Rozentsveig V, Neulander E, Roussabrov E, Schwartz A, Lismer L, Gurevich B, et al. Anaesthetic considerations during percutaneous nephrolithotomy. J Clin Anesth. 2007;19(5):351-5.
9. Mehrabi S, Karimzadeh Shirazi K. Results and complications of spinal anaesthesia in percutaneous nephrolithotomy. Urol J. 2010;7(1):22-5.
10. Stoller M, Wolf J, Lezin M. Estimated blood loss and transfusion rate associated with percutaneous nephrolithotomy. J Urol. 1994;152:1977-81.
11. Trivedi N, Robalino J, Shevde K. Interpleral block: a new technique for regional anaesthesia during percutaneous nephrostomy and nephrolithotomy. Can J Anesth. 1990;37:479-81.
12. El-Husseiny T, Moraitis K, Maan Z, Papatsoris A, Saunders P, Golden B, et al. Percutaneous endourologic procedures in high-risk patients in the lateral decubitus position under general anaesthesia. J Endorol. 2009(23):1603-6.
13. Kuzgunbay B, Turunc T, Akin S, Ergenoglu P, Aribogan A, Ozkardes H. Percutaneous nephrolithotomy under general versus combined spinal-epidural anaesthesia. J Endorol. 2009;23:1835-8.
14. Kanaroglou A, Razvi H. Percutaneous nephrolithotomy under consious sedation in morbidly obese patients. Can J Urol. 2006;13:3153-5.
15. Karacalar S, Bilen C, Sarihasan B, Sarikaya S. Spinal epidural anaesthesia versus general anaesthesia in the management of percutaneous nephrolithotomy. J Endorol. 2009;23:1835-8.
16. Cicek T, Gonulalan U, Dogan R, Kosan M, Istanbulluoglu O, Gonen M, et al. Spinal anesthsia is an efficient and safe anesthetic method for percutaneous nephrolithotoy. Urology. 2014;83(1):50-5.
17. Taghipour Anvari Z, Afshar-Fereydouniyan N, Imani F, Sakhaei M, Alijani B, Mohseni M. Effect of clonidine premedication on blood loss in spine surgery. Anesth Pain. 2011;1(4):252-6.
18. Tetzlaff J, Dilger J, Kodsy M, Al-Bataineh J, Yoon H, Bell G. Spinal anaesthesia for elective lumbar spine surgery. J Clin Anesth. 1998;10(8):666-9.
19. Sunana G, Rahul G, Nandita M, Arti M, Sidhartha V, Rajesh M. Percutaneous nephrolithotomy under spinal anesthesia and the efficacy of adding adjuvant clonidine to intrathecal hyperbaric bupivacaine: a comparative study. Internet J Anesthesiol. 2014;33(1).
20. Movasseghi G, Hassani V, Mohaghegh M, Safaeian R, Safari S, Zamani M, et al. Comparision between spinal and general anesthesia in percutaneous nephrolithotomy. Anesth Pain Med. 2014;4(1):e1387.
Published
2016-12-23
How to Cite
Shah, R., Thapa, A., Lamichhane, N., & KC, S. (2016). Safety and Efficacy of Spinal Anaesthesia in Percutaneous Nephrolithotomy. Journal of Nepal Medical Association, 55(204), 61-66. https://doi.org/10.31729/jnma.2846
Section
Original Article