Results of Percutaneous Nephrolithotomy under Spinal Anesthesia

Authors: Babak Borzouei, Seyed Habibollah Mousavi-Bahar

Abstract:

Recently, there has been a considerable increase in the number of procedures carried out under regional anesthesia. However, percutaneous nephrolithotomy (PCNL) procedures are usually performed under general anesthesia. The aim of this study was to assess the safety and efficacy of PCNL under spinal anesthesia in patients with renal calculi. We describe our 9 years experience of performing PCNL under spinal anesthesia for 387 patients with large stones of the upper urinary tract, with regard to the effectiveness and side effects. All patients received spinal anesthetics (Lidocain 5%, or Bupivacaine 0.75%) and underwent PCNL in prone position. The success rate was 94.1%. The incidence of complications was 11.6%. PCNL under spinal anesthesia is feasible, safe, and well-tolerated in management of patients with renal stones.

Keywords: percutaneous nephrolithotomy, spinal anesthesia, renal calculi

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1074720

References:

[1] I. Fernström, B. Johansson, "Percutaneous Nephrolithotomy: A new extraction technique" Scand J Urol Nephrol, vol. 10, pp. 257-259, 1976.
[2] MY. Wong, "Evolving technique of Percutaneous Nephrolithotomy in a developing country: Singapore General Hospital experience" J Endourol, vol. 12, pp. 397-401, Oct 1998.
[3] A. Basiri, S. Mehrabi, H. Kianian, A. Javaherforooshzadeh, "Blind puncture in comparison with fluoroscopic guidance in Percutaneous Nephrolithotomy: a randomized controlled trial" Urol J, vol. 4, pp. 79- 83, Spring 2007.
[4] JW. Segura, GM. Preminger, DG. Assimos, et al, "Nephrolithiasis Clinical Guidelines Panel summery report on the management of staghorn calculi" Urol J, vol. 151, pp. 1648, Jun 1994.
[5] I. Singh, A. Kumar, P. Kumar, "Ambulatory PCNL" (tubeless PCNL under regional anesthesia) - a preliminary report of 10 cases" Int Urol Nephrol, vol. 37, pp. 35-37, 2005.
[6] DL. Brown, "Spinal, Epidural, and caudal Anesthesia" in Miler's Anesthesia, 7th ed. vol. 1, RD. Miller, LI. Eriksson, LA. Fleisher, JP. Wiener-Kronish, WL. Young, Ed. Philadelphia, Churchill Livingstone Elsevier, 2010; pp: 1611-1638.
[7] NS. Trivedi, J. Robalino, K. Shevde, "Interpleural block: A new technique for regional anesthesia during percutaneous nephrostomy and Nephrolithotomy" Can J Anaesth, vol. 37, pp. 479-481, May 1990.
[8] MM. Saied, ZM. Sonbul, M. el-Kenawy, et al, "Spinal and interpleural Bupivaccaine for percutaneous Nephrolithotomy" Middle East J Anesthesiol, vol. 11, pp. 259-264, Oct 1991.
[9] C. Andreoni, EO. Olweny, AJ. Portis, CP. Sundaram, T. Monk, RV. Clayman, "Effect of single-dose subarachnoid spinal anesthesia on pain and recovery after unilateral percutaneous nephrolithotomy" J Endourol, vol. 16, pp. 721-725, Dec 2002.
[10] E. Aravantinos, A. Karatzas, S. Gravas, V. Tzortzis, M. Melekos, "Feasibility of percutaneous nephrolithotomy under assisted local anesthesia: a prospective study on selected patients with upper urinary tract obstruction" Eur Urol, vol. 51, pp. 224-227, Jan 2007.
[11] V. Rozentsveig, EZ. Neulander, E. Roussabrov, et al, "Anesthetic considerations during percutaneous nephrolithotomy" J Clin Anesth, vol. 19, pp. 351-355, Aug 2007.
[12] V. Ballestrazzi, C. Zboralski, P. Smith-Morel, M. Boullet, I. Willot, D. Hochart, P. Scherpereel, "
[Importance of suspended peridural anesthesia in percutaneous nephrolithotomy. Apropos of 112 patients in the urology service of the Regional Hospital Center of life.]" (fre) Cah Anesthesiol, vol. 36, pp. 85-88, Mar-Apr 1988.
[13] T. El-Husseiny, K. Moraitis, Z. Maan, A. Papatsoris, P. Saunders, B. Golden, J. Masood, NP. Buchholz, "Percutaneous endourologic procedures in high-risk patients in the lateral decubitus position under regional anesthesia" J Endourol, vol. 23, pp. 1603-1606, Oct 2009.
[14] B. Kuzgunbay, T. Turunc, S. Akin, P. Ergenoglu, A. Aribogan, H. Ozkardes, "Percutaneous nephrolithotomy under general versus combined spinal-epidural anesthesia" J Endourol, vol. 23, pp. 1835- 1838, Nov 2009.
[15] C. Andreoni, EO. Olweny, AJ. Portis, CP. Sundaram, T. Monk, RV. Clayman, "Effect of single-dose subarachnoid spinal anesthesia on pain and recovery after unilateral percutaneous nephrolithotomy" J Endourol, vol. 16, pp. 721-725, Dec 2002.
[16] S. Mehrabi, K. Karimzadeh Shirazi, "Results and complications of spinal anesthesia in percutaneous nephrolithotomy" Urol J, vol. 7, pp. 22-25, Winter 2010.