Comparison of Percutaneous Nephrolithotomy Under Spinal Versus General Anesthesia: A Randomized Clinical Trial

Nouralizadeh, Akbar; Ziaee, Seyed Amir Mohsen; Sharifi, Seyed Hossein Hosseini; Basiri, Abbas; Tabibi, Ali; Sharifiaghdas, Farzaneh; Kilani, Hossein; Gharaei, Babak; Roodneshin, Fatemeh; Soltani, Mohammad Hossein

doi:10.1089/end.2013.0145

Cited by 30 publications

(20 citation statements)

References 21 publications

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“…Multiple studies [35][36][37] demonstrated comparative complication rates and Clavien classification of complications for general and spinal anesthesia similar to our results, although Cicek complications in Pcnl and colleagues reported higher minor complications (grades I-II), lower major complications (grades ≥IIIa), and lower rates of thce grades of II-IIIb and IVb for spinal anesthesia. 35 We found that imaging for access did not affect MCC in multivariate analysis.…”

Section: Discussionsupporting

confidence: 87%

Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy

Falahatkar¹,

Moghaddam

Kazemnezhad³

et al. 2015

CUAJ

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Cite as: Can Urol Assoc J 2015;9(1-2):e83-92. http://dx.doi.org/10.5489/cuaj.2248 Published online February 9, 2015. AbstractIntroduction: An increase in percutaneous nephrolithotomy (PCNL) has been accompanied by an increase in complications. We identified the parameters affecting the severity of complications using the modified Clavien classification (MCC). Methods: From 2008 to 2013, 330 patients underwent complete supine PCNL using subcostal access, one-shot dilation, rigid nephroscopy, and pneumatic lithotripsy. We assessed the impact of the following factors on complication severity based on the MCC: age, gender, body mass index, hypertension, diabetes, previous stone surgery and extracorporeal shock wave lithotripsy, preoperative hemoglobin, renal dysfunction (creatinine >1.4 mg/dL), preoperative urinary tract infection, anatomic upper urinary tract abnormality (AUUTA), significant (moderate-severe) hydronephrosis, stonerelated parameters (opacity, number, burden, location, staghorn, complex stones), anesthesia type, kidney side, imaging and calyx for access, tract number, tubeless approach, operative time, postoperative hemoglobin, and hemoglobin drop and stone-free results. Results: The complication rate was 19.7% (MCC: 0=80.3%, I=6.4%, II=11.2%, ≥III=2.1%). On univariate analyses, only the following factors affected MCC: gender, preoperative hemoglobin, AUUTA, significant hydronephrosis, imaging for access, calyx for access, tract number, postoperative hemoglobin, hemoglobin drop and stone-free result. Renal dysfunction was accompanied by higher complications, yet the results were not statistically significant. Multivariate logistic regression analysis demonstrated renal dysfunction, absence of significant hydronephrosis, AUUTA, multiple tracts, lower postoperative hemoglobin, and higher postoperative hemoglobin drop as the significant parameters which affected MCC and predicted higher grades. The paper's limitations include a low number of cases in the higher Clavien grades and some subgroups of variables, and not applying some techniques due to surgeon preference. Interpretation: Many of the complete supine PCNL complications were in the lower Clavien grades and major complications were uncommon. Renal dysfunction, AUUTA, significant hydronephrosis, tract number, postoperative hemoglobin, and hemoglobin drop were the only factors affecting MCC. IntroductionPresently, percutaneous nephrolithotomy (PCNL) is preferred as a safe and effective way to remove large or multiple upper urinary tract calculi. [1][2][3][4][5][6][7] An increase in PCNL has been accompanied by variations in positions, techniques, and instruments, and these may have led to increased complications.1,2,4,5 Following PCNL, 79.5% of patients may experience an uncomplicated postoperative period, 5,8 although there are reports of an early complication rate of 50.8%. 4PCNL complications may occur during puncturing, access, or stone removal. 4 A standardized classification allow us to compare complications among different instruments, te...

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Section: Discussionsupporting

confidence: 87%

Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy

Falahatkar¹,

Moghaddam

Kazemnezhad³

et al. 2015

CUAJ

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“…Several studies report lower levels of postoperative pain for PCNL procedures undertaken with spinal or epidural anesthesia compared with GA. [9][10][11] However, in RIRS, pain assessed at multiple postoperative time points was not significantly different in patients who had CSEA compared with patients who had GA. The reason may be explained by the minimally invasive nature of the RIRS procedure, which itself is associated with slight postoperative pain.…”

Section: Discussionmentioning

confidence: 82%

Retrograde Intrarenal Surgery with Combined Spinal-Epidural vs General Anesthesia: A Prospective Randomized Controlled Trial

Zeng

Zhao

Yang

et al. 2015

Journal of Endourology

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Objective: Retrograde intrarenal surgery (RIRS) involves a minimally invasive stone surgery, lending itself potential to combined spinal-epidural anesthesia (CSEA), although it is performed preferably under general anesthesia (GA). This prospective randomized study was undertaken to evaluate the feasibility and efficacy of CSEA for patients undergoing RIRS. Patients and Methods: Seventy consecutive patients who were scheduled for RIRS were randomized to receive CSEA (n = 35) or GA (n = 35). Operative time, stone clearance rate, visual analog scale (VAS) of pain, complication rate, anesthetic cost, and hospital stay were compared between the two groups. Results: A total of 65 patients randomized to CSEA (31) or GA (34) completed the study. In the CSEA group, each procedure was completed and there was no anesthetic conversion. Although based on the prospective randomized method, the GA group still had a little larger stone size ( p = 0.059) and more multiple caliceal stones ( p = 0.037). Overall, there were no statistically significant differences in operative time ( p = 0.088), stone fragmentation time ( p = 0.074), postoperative VAS pain score at 6 and 24 hours ( p = 0.156, 0.146), incidence of complications ( p = 0.870), stone-free rate ( p = 0.804), and hospital stays ( p = 0.907) between the two groups. The patients in the GA group experienced a higher mean hemoglobin drop (6.5 -3.2 vs 8.6 -2.7 g/L, p = 0.012). In addition, the anesthetic cost was much cheaper in the CSEA group (183.8 -31.4 vs 391.9 -59

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“…11,18,25,26,28 Karacalar Serap et al studied 180 patients undergoing PCNL, concluded that CSE gave greater patient satisfaction, shorter times for PACU and home readiness, and less postoperative pain (p = 0.001). 20 Elbeally et al conducted a study on 57 patients undergoing PCNL in GA, epidural anaesthesia (EA) and paravertebral block (P).…”

Section: Postoperative Painmentioning

confidence: 99%

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

et al. 2016

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Comparison of Percutaneous Nephrolithotomy Under Spinal Versus General Anesthesia: A Randomized Clinical Trial

Abstract: It seems that using spinal anesthesia by intrathecal injection of local anesthetic solutions vs general anesthesia has comparable surgical outcomes and reduces the requirement for analgesia after PCNL in the early postoperative period.

Cited by 30 publications

References 21 publications

Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy

Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy

Retrograde Intrarenal Surgery with Combined Spinal-Epidural vs General Anesthesia: A Prospective Randomized Controlled Trial

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

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