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. 2017 Apr;61(4):308-314.
doi: 10.4103/0019-5049.204247.

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

Devangi A Parikh  1 , Geeta A Patkar  1 , Mayur S Ganvir  1 , Ajit Sawant  2 , Bharati A Tendolkar  1
Affiliations

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

Devangi A Parikh et al. Indian J Anaesth. 2017 Apr.

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.

Keywords: General anaesthesia; percutaneous nephrolithotomy; segmental epidural anaesthesia.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Changes in heart rate intraoperatively and in PACU. Time '0' intubation/ epidural drug injection. Data expressed as mean (Standard deviation).*P<0.05.
Figure 2
Figure 2
Changes in mean arterial pressure intraoperatively and in PACU. Time '0' intubation/ epidural drug injection. Data expressed as mean (Standard deviation)*P<0.05
See this image and copyright information in PMC

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