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

Nilam D. Virkar; Geeta A. Patkar; R. Rohit; Bharati A. Tendolkar

doi:10.18203/2320-6012.ijrms20162614

Authors

Nilam D. Virkar Department of Anesthesiology, LTMMC & LTMGH, Sion, Mumbai, Maharashtra
Geeta A. Patkar Department of Anesthesiology, LTMMC & LTMGH, Sion, Mumbai, Maharashtra
R. Rohit Department of Anesthesiology, LTMMC & LTMGH, Sion, Mumbai, Maharashtra
Bharati A. Tendolkar Department of Anesthesiology, LTMMC & LTMGH, Sion, Mumbai, Maharashtra

DOI:

https://doi.org/10.18203/2320-6012.ijrms20162614

Keywords:

Percutaneous nephrolithotomy, Spinal epidural anaesthesia, Hypotension, Postoperative nausea and vomiting, Post-operative pain

Abstract

Background: Our primary aim was to study the efficacy, safety, hemodynamic stability, postoperative pain relief, and complication with combined spinal epidural anaesthesia (CSE) and to compare it with general anaesthesia (GA) for percutaneous nephrolithotomy (PCNL).

Methods: The present study was a prospective, randomized, open, controlled trial to compare the effects of CSE and GA in patients undergoing PCNL. Study was carried out in 100 adult patients, who were randomly divided into two groups of 50 each, Group GA and Group CSE. Post-operative pain relief and amount rescue analgesia required were noted. Postoperatively samples were collected for haemoglobin and arterial blood gases. Incidence of complications were noted and compared among both the groups.

Results: Mean arterial pressure in CSE group was less compared to GA group during the procedure. 30 % patients in group GA required first rescue analgesia within first hour of completion of surgery whereas no patient in group CSE required analgesia within first hour indicating better pain relief in CSE group. Mean haemoglobin and the fall in haemoglobin between the groups were comparable. 48.0% of the cases among GA group and 14.0% of the cases among CSE group had postoperative nausea and vomiting. Mean pH in GA group was 7.33±0.05 and in CSE group was 7.36±0.04. There was one case of hydrothorax post operatively.

Conclusions: We conclude that CSE is a safe alternative to GA for PCNL with better pain relief, less PONV. Hypotension due to sympathetic blockade is always a possibility.

Metrics

Metrics Loading ...

References

Basiri A, Mehrabi S, Kianian H, Javaherforooshzadeh A. Blind puncture in comparison with fluoroscopic guidance in percutaneous nephrolithotomy: a randomized controlled trial. Urol J. 2007;4:79-83.

Lojanapiwat B, Prasopsuk S. Upper-pole access for percutaneous nephrolithotomy: comparison of supracostal and infracostal approaches. J Endourol 2006;20:491-4.

Gravenstein D. Extracorporeal wave lithotripsy and percutaneous nephrolithotripsy. Anesthesiol Clin N Am. 2000;18:953-71.

De Rojas JO, Syre P, Welch WC. Regional anesthesia versus general anesthesia for surgery on the lumbar spine: a review of the modern literature. Clin Neurol Neurosurg. 2014;119:39-43.

Kuzgunbay B, Turunc T, Akin S, Ergenoglu P, Aribogan A, Ozkardes H. Percutaneous nephrolithotomy under general versus combined spinal-epidural anesthesia. J Endourol. 2009;23:1835-8.

Peterson GN, Krieger JN, Glauber DT. Anaesthetic experience with percutaneous lithotripsy: A review of potential and actual complications. Anaesthesia. 1985;40:460-4.

Pu C, Wang J, Tang Y, Yuan H, Li J, Bai Y, et al. The efficacy and safety of percutaneous nephrolithotomy under general versus regional anesthesia: a systematic review and meta‑analysis. Urolithiasis. 2015;43:455-66.

Cicek T, Gonulalan U, Dogan R, Kosan M, Istanbulluoglu O, Gonen M, et al. Spinal anesthesia is an efficient and safe anesthetic method for percutaneous nephrolithotomy. Urology. 2014;83:50-5.

Gonen M, Basaran B. Tubeless percutaneous nephrolithotomy: spinal versus general anesthesia. Urol J. 2014;11:1211-5.

Movasseghi G, Hassani V, Mohaghegh MR, Safaeian R, Safari S, Zamani MM, et al. Comparison between spinal and general anesthesia in percutaneous nephrolithotomy. Anesth Pain Med. 2014;4:e13871.

Mehrabi S, Mousavi ZA, Akbartabar TM, Mehrabi F. General versus spinal anesthesia in percutaneous nephrolithotomy. Urol J. 2013;10:756-61.

Antonelli JA, Pearle MS. Advances in percutaneous nephrolithotomy. Urol Clin North Am. 2013;40:99-113.

Moslemi MK, Mousavi-Bahar SH, Abedinzadeh M. The feasibility of regional anesthesia in the percutaneous nephrolithotomy with supracostal approach and its comparison with general anesthesia. Urolithiasis. 2013;41:53-7.

Kim SS, Lee JW, Yu JH, Sung LH, Chung JY, Noh CH. Percutaneous nephrolithotomy: comparison of the efficacies and feasibilities of regional and general anesthesia. Korean J Urol. 2013;54:846-50.

Rodgers A, Walker N, Schug S, McKee A, Kehlet H, Zundert AV, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomized trials. BMJ. 2000;321:1493.

Ko R, Soucy F, Denstedt JD, Razvi H. Percutaneous nephrolithotomy made easier: a practical guide, tips and tricks. BJU Int. 2008;101:535-9.

Pakravan M, Kiavash V, Moradian S. Posterior ischemic optic neuropathy following percutaneous nephrolithotomy. Iran J Ophthalmic Res. 2007;2(1):76-80.

Singh V, Sinha RJ, Sankhwar SN, Malik A. A prospective randomized study comparing percutaneous nephrolithotomy under combined spinal-epidural anesthesia with percutaneous nephrolithotomy under general anesthesia. Urol Int. 2011;87:293-8.

Mehrabi S, Kambiz S. Results and complications of spinal anesthesia in percutaneous nephrolithotomy. Urol J. 2010;7:22-5.

Karacalar S, Bilen CY, Sarihasan B , Sarikaya S. spinal-epidural anesthesia versus general anesthesia in the management of percutaneous nephrolithotripsy. J Endourol. 2009;23(10):1591-7.

Elbealy ME, Rashwan MD, Kasim MS, Abbas MS. A comparison of the effects of epidural anaesthesia, lumbar paravartebral block and general anaesthesia in percutaneous nephrolithotomy. J Med Sci. 2008;8(2):170-6.

Vorrakitpokatorn P, Permtongchuchai K. Perioperative complications and risk factors of percutaneous nephrolithotomy. J Med Assoc Thai. 2006;89(6):826-33.

Watanabe N, Mishima K, Nezu T, Tanifuji Y, Kobayashi K. Sudden cardiac arrest during percutaneous nephrostolithotomy under epidural anesthesia. Masui. 1990;39:253-6.

Aravantinos E, kalogeras N, Melekos M, Theodorou E. PCNL under multimodal analgesia. J Endourol. 2009;23(5):853-6.

Nouralizadeh A, Ziaee SA, Hosseini SS, Basiri A, Tabibi A, Sharifiaghdas F, Kilani H, Gharaei B, Roodneshin F, Soltani MH. Comparison of percutaneous nephrolithotomy under spinal versus general anesthesia: a randomized clinical trial. J Endourol. 2013;27:974-8.

Tangpaitoon T, Nisoog C, Lojanapiwat B. Efficacy and safety of percutaneous nephrolithotomy (PCNL): a prospective and randomized study comparing regional epidural anesthesia with general anesthesia. Int Braz J Urol. 2012;38:504-11.

Srivastava A, Singh KJ, Suri A, Dubey D, Kumar A, Kapoor R, et al. Vascular complications after percutaneous nephrolithotomy: are there any predictive factors? Urology. 2005;66:38-40.

Akman T, Binbay M, Sari E, Yuruk E, Tepeler A, Akcay M, et al. Factors affecting bleeding during percutaneous nephrolithotomy: Single Surgeon Experience. J Endourol. 2011;25(2):327-33.

Chung F, Mezei G. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg. 1999;89:1352–9.

Mohta M, Bhagchandani T, Tyagi T, Pendse M, Sethi AK. Haemodynamic, electrolyte and metabolic changes during percutaneous nephrolithotomy. Int Urol Nephrol. 2008;40:477-82.

Atici S, Zeren S, Ariboğan A. Hormonal and hemodynamic changes during percutaneous nephrolithotomy. Int Urol Nephrol. 2001;32(3):311-4.

Munver R, Delvecchio FC, Newman GE, Preminger GM. Critical analysis of supracostal access for percutaneous renal surgery. J Urol. 2001;166:1242-6.

Mousavi-Bahar SH, Mehrabi S, Moslemi MK. Percutaneous nephrolithotomy complications in 671 consecutive patients a single-center experience. Urol J. 2011;8:271-6.

Gupta R, Kumar A, Kapoor R, Srivastava A, Mandhani A. Prospective evaluation of safety and efficacy of the supracostal approach for percutaneous nephrolithotomy. BJU Int. 2002;90:809-13.

Desai AC, Jain S, Benway BM, Grubb III RL, Picus D, Figenshau RS. Splenic injury during percutaneous nephrolithotomy: A Case Report with Novel Management Technique. J Endourol. 2010;24(4):541-5.

K roglu A, Togal T, Cicek M, Kilic S, Ayas A, Ersoy M. The effects of irrigation fluid volume and irrigation time on fluid electrolyte balance and hemodynamics in percutaneous nephrolithotripsy. Internat Urol Nephrol. 2003;35:1-6.

Cadeddu JA, Chen R, Bishoff J, Micali S, Kumar A, Moore RG, et al. Clinical significance of fever after percutaneous nephrolithotomy. Urology. 1998;52:48-50.

Mariappan P, Tolley DA. Endoscopic stone surgery: minimize risk of postoperative sepsis. Current Opin Urol. 2005;15:101-5.