Comparison of percutaneous nephrolithotomy under epidural anesthesia versus general anesthesia: A randomized prospective study

Dar, Manzoor Ahmad; Malik, Sajad Ahmad; Dar, Yaser Ahmed; Wani, Prince Muzafer; Wani, Mohammad Saleem; Hamid, Arif; Khawaja, Abdul Rouf; Sofi, Khalid

doi:10.4103/ua.ua_82_20

Cited by 5 publications

(5 citation statements)

References 22 publications

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“…15 Dar et al, found no difference in these parameters in their comparative study. 19 Patients in the GA group experienced a higher level of pain (as measured by the VAS) at the end of the procedure than the SA and CSEA groups in this study; however, the VAS scores were similar at the 24-h interval. These findings were also echoed by Dar et al, 19 Pu et al,and Liu et al, reported that the RA group experienced continued pain relief with lower VAS scores even after 24 h, but similar VAS scores after 48 h. 15,17 Therefore, RA appears to provide superior post-operative comfort to patients.…”

Section: Discussionmentioning

confidence: 49%

Finding the optimal anesthetic technique during PCNL for renal stone disease: A comparison of general, spinal, and combined spinal epidural anesthesia

et al. 2023

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Background: Renal stone disease is prevalent worldwide. Percutaneous nephrolithotomy (PCNL) has become an important mode of treatment for large size renal stones. Various anesthetic techniques have described for performing PCNL, with each having its own merits and demerits. There is lacuna in evidence for the ideal mode of anesthesia with best results and least associated complications. Aims and Objectives: PCNL is a common procedure for renal stones. It can be performed under various anesthesia techniques. Selection of an appropriate anesthetic technique is essential for successful outcome. In this study, we compared three anesthesia techniques during PCNL and their outcomes. Materials and Methods: Retrospective and observational study involved all cases of PCNL performed from February 2022 to January 2023. Baseline clinical and anesthesia parameters were recorded. Three groups based on anesthesia method were made; Group A for general anesthesia (GA), B for spinal anesthesia (SA), and C for combined spinal epidural anesthesia (CSEA). Intraoperative variables including heart rate (HR), blood pressure, operation time, and analgesia adequacy were noted. Post-operative pain level, hospital stay, stone free rate (SFR), complications, patient, and surgeon satisfaction were recorded. Results: Seventy-two cases (56 Male and 16 Female) with a mean age of 36.2±15.9 years were included in the study. Age and body mass index were lower in Group A, while ASA status and comorbidities were comparable. Intraoperative HR and mean blood pressure were higher in Group A than in B and C (P=0.000, P=0.003). Hypotension was more frequent in Group B (24.1%, P=0.046). Operation time, hospital stay, transfusion rates, SFR, and overall patient satisfaction were similar. Group A patients experienced more post-procedure pain (Visual analogue scale 4.1 vs. 2.2 vs. 2.1; P=0.001). Nausea-vomiting and shivering episodes were also higher in Group A (P=0.033, P=0.021). Anesthetic effect weaned-off in 6 patients of SA. Post-operative headache was higher but non-significant in Group B and C (P=0.621). Conclusion: CSEA appears a superior alternative to both SA and GA, with additional adequate post-operative comfort.

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Section: Discussionmentioning

confidence: 49%

Finding the optimal anesthetic technique during PCNL for renal stone disease: A comparison of general, spinal, and combined spinal epidural anesthesia

et al. 2023

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“…Secondly, our results found that regional anaesthesia had a lower postoperative nausea and vomiting rate and a lower immediate postoperative visual analog pain score [ 13 , 14 , 19 ]. Although these two approaches had no significant difference in postoperative visual analog pain score at 12 hours and 24 hours, these findings indicate the advantages of regional anaesthesia compared to general anaesthesia in PCNL.…”

Section: Discussionmentioning

confidence: 99%

Regional versus general anaesthesia in percutaneous nephrolithotomy: a systematic review and meta-analysis

2024

Cent Eur J Urol

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Introduction Several studies have compared the safety and effectiveness of general and regional anaesthesia in percutaneous nephrolithotomy (PCNL). This study aimed to compare the perioperative and postoperative outcomes of general anaesthesia and regional anaesthesia for patients undergoing PCNL. Material and methods For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until March 2023. A meta-analysis has been reported in line with PRISMA 2020 and AMSTAR Guidelines. The risk ratio (RR) and mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CI). Results The final cohort analysis, comprised 3871 cases of PCNL, (2154 regional anaesthesia and 1717 general anaesthesia). Compared to general anaesthesia, the regional anaesthesia group had a significantly shorter length of stay (MD = -0.34 days, 95% CI -0.56 to -0.12, p = 0.002), lower postoperative nausea and vomiting rates (RR = 0.16, 95% CI 0.03 to 0.80, p = 0.026), lower complications grade III–V rates (RR = 0.68, 95% CI 0.53 to 0.88, p = 0.004), and lower postoperative visual analogue pain score (VAS) at 1 hour (MD = -3.5, 95% CI -4.1 to -2.9, p <0.001). There were no significant differences in other outcomes between the two groups. Conclusions Our results show that PCNL under regional anaesthesia is safe and feasible, with comparable results to those done under general anaesthesia. While patient selection is important, counselling and decision-making for these procedures must go hand in hand to achieve the best clinical outcome.

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“…For both total and partial staghorn calculi, Winfield et al reported an 86% stone-free rate with percutaneous nephrolithotomy monotherapy, while SWL monotherapy resulted in 39% of patients still having some stone burden at 8 months after treatment completion 33 . The evolution of stone treatment strategies highlights the gradual shift towards less invasive methods 34,35 .…”

Section: Discussionmentioning

confidence: 99%

Stone clearance rate in patients treated with open surgery versus percutaneous nephrolithotomy for the management of staghorn renal calculi.

Ajmal Khan,

Tanzeel Gazder,

Nisar Ahmed

et al. 2023

Int. j. endorsing health sci. res.

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Background: Urinary calculi, particularly staghorn renal calculi, pose a significant health challenge. Percutaneous nephrolithotomy (PCNL) and open surgery are two distinct surgical interventions employed for treating staghorn renal calculi. This study aimed to compare the stone clearance rates of patients undergoing open surgery versus percutaneous nephrolithotomy at the Department of Urology, Sindh Institute of Urology and Transplantation (SIUT) in Karachi, Pakistan. Methodology: A prospective cohort study was conducted from February 8th to August 7th, 2019. Patients aged 18 to 60 years, diagnosed with staghorn renal calculi, were included. Patients with other renal stones and untreated urinary tract infections were excluded. The study enrolled 230 patients, divided into two groups: Group I underwent percutaneous nephrolithotomies, and Group II underwent open surgery. Stone clearance was assessed through post-surgery X-ray KUB. Results: The mean age of participants was 44.99 years, with a balanced gender distribution. Both PCNL and open surgery achieved stone clearance rates of 68.7%, with significantly higher rates observed in the PCNL group (74.8% vs. 62.6%, p = 0.04). Stratification by age, gender, illness duration, and stone location did not yield substantial variations in stone clearance rates. Conclusion: PCNL demonstrated a superior stone clearance rate compared to open surgery in the treatment of staghorn renal calculi. This finding highlights the potential of PCNL as a more effective intervention for addressing this challenging urological condition.

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Comparison of percutaneous nephrolithotomy under epidural anesthesia versus general anesthesia: A randomized prospective study

Cited by 5 publications

References 22 publications

Finding the optimal anesthetic technique during PCNL for renal stone disease: A comparison of general, spinal, and combined spinal epidural anesthesia

Finding the optimal anesthetic technique during PCNL for renal stone disease: A comparison of general, spinal, and combined spinal epidural anesthesia

Regional versus general anaesthesia in percutaneous nephrolithotomy: a systematic review and meta-analysis

Stone clearance rate in patients treated with open surgery versus percutaneous nephrolithotomy for the management of staghorn renal calculi.

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