Comparison of thoracic segmental spinal anaesthesia and lumbar spinal anaesthesia for percutaneous nephrolithotomy
Keywords:Isobaric ropivacaine, Nephrolithotomy, Spinal anesthesia, Thoracic segmental
Background: Randomised controlled study aimed to compare 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 of our study was to evaluate the feasibility and safety of TSSA for PCNL and to compare 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) upper. Sensory block levels were T6 for both groups, but lower level in TSSA was 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 with lesser incidence of and reducing intra-operative hypotension compared to conventional LSA.
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