The feasibility of regional anesthesia in the percutaneous nephrolithotomy with supracostal approach and its comparison with general anesthesia

Abstract

There are various approaches for the percutaneous nephrolithotomy (PCNL). Supracostal approach is a well known technique for doing of it. This approach is being done commonly under general anesthesia (GA). In this retrospective study, we evaluated the feasibility of supracostal PCNL under regional anesthesia (RA) and compared it with the same procedure under GA. Since March 2000 to March 2005, a total of 123 renal stone cases underwent PCNL with supracostal access in our center. GA was selected in 69 cases (56%) (Group 1), spinal anesthesia (SA) in 45 cases (36.5%), and epidural anesthesia (EA) in 9 cases (7.5%) (Group 2). The operative time, success rate, hospital stay, and ensuing complications were compared between group 1 and group 2. There were no significant differences between groups 1 and 2 among surgical parameters, including age, stone area, anesthesia time, and hospitalization time (P>0.05). There was no difference in the rate of complications or success rate between GA and RA cases (P>0.05). Overall complete stone free rate, regardless of stone size, in relation to type of anesthesia was as follows: 88.4% for GA, 88.9% for EA, and 91.1% for SA (P>0.05). Conversion to GA was not needed in any patient with RA. The results showed that the supracostal PCNL with regional anesthesia was feasible but without evident advantages versus general anesthesia in this population, and possible advantages of the procedure in patients with pulmonary co-morbidities have still to be evaluated. The anesthesia related complications of RA were negligible and easily controllable.