Is segmental epidural anaesthesia an optimal technique for patients undergoing percutaneous nephrolithotomy?

Abstract

Background and Aims:Neuraxial anaesthesia has recently become popular for percutaneous nephrolithotomy (PCNL). We conducted a study comparing general anaesthesia (GA) with segmental (T6–T12) epidural anaesthesia (SEA) for PCNL with respect to anaesthesia and surgical characteristics.Methods:Ninety American Society of Anesthesiologists Physical Status-I and II patients undergoing PCNL randomly received either GA or SEA. Overall patient satisfaction was the primary end point. Intraoperative haemodynamics, epidural block characteristics, post-operative pain, time to rescue analgesic, total analgesic consumption, discharge times from post-anaesthesia care unit, surgeon satisfaction scores and stone clearance were secondary end points. Parametric data were analysed by Student's t-test while non-parametric data were compared with Mann–Whitney U-test.Results:Group SEA reported better patient satisfaction (P = 0.005). Patients in group GA had significantly higher heart rates (P = 0.0001) and comparable mean arterial pressures (P = 0.24). Postoperatively, time to first rescue analgesic and total tramadol consumption was higher in Group GA (P = 0.001). Group SEA had lower pain scores (P = 0.001). Time to reach Aldrete's score of 9 was shorter in group SEA (P = 0.0001). The incidence of nausea was higher in group GA (P = 0.001); vomiting rates were comparable (P = 0.15). One patient in group SEA developed bradycardia which was successfully treated. Eight patients (18%) had hypertensive episodes in group GA versus none in group SEA (P = 0.0001). One patient in GA group had pleural injury and was managed with intercostal drain. Stone clearance and post-operative haemoglobin levels were comparable in both groups.Conclusion:PCNL under SEA has a role in selected patients, for short duration surgery and in expert hands.

Does Severe Obesity Effect Early Postoperative Recovery and Surgical Outcomes in Patients Undergoing Percutaneous Nephrolithotomy Under Spinal Anesthesia?

“…In a study comparing general anesthesia and segmental epidural anesthesia for PNL, the time it took to reach Aldrete's score of 9 was 27.2±5.6 for general anesthesia and 10.4±4.1 for segmental epidural anesthesia. The mean BMI of the study cohort was 22 kg/m 2 with no statistical difference between groups (27).…”

Comparison of the effects of general, spinal and epidural anesthesia on ureter access and surgical outcomes during flexible ureterorenoscopy for transurethral single stone removal surgeries: a monocentric retrospective study

“…The results of the intraoperative characters of the present study agreed with those of a prospective randomized study [ 3 ]. Regional and spinal anaesthesia is not enough to provide relaxation of distal ureters to access stone [ 5 , 10 , 12 ]. The use of medications including α -blockers, calcium channel blockers, etc.…”

“…In ureterorenoscopy, anaesthesiologists prefer regional anaesthesia to avoid complications due to general anaesthesia [ 3 ], while surgeons prefer general anaesthesia to avoid ureteral trauma [ 9 ]. Prospective randomized studies [ 3 , 10 , 11 ] show that the anaesthesia method has effects on ureteral access and influences ureteral entrance through surgical success but they have a small sample size. In literature, ureterorenoscopy is described under general anaesthesia, local anaesthesia, sacral block, and spinal anaesthesia [ 12 , 13 ].…”

Comparison of postoperative analgesia and opioid requirement with thoracic epidural vs. continuous rectus sheath infusion in midline incision laparotomies under general anaesthesia – A prospective randomised controlled study

“…A test dose of 3 mL of lignocaine 2% with adrenaline (1:200,000) was given after negative aspiration for blood and cerebrospinal fluid (CSF), to rule out intravascular placement. [ 3 ] The catheter was then secured with Lockit Plus™ 18G (Smith medical, Keene, USA) and transparent dressing. Before the reversal of anaesthesia, epidural bolus was given with 10 mL of 0.2% ropivacaine after negative aspiration for blood and CSF.…”