You have accessJournal of UrologyStone Disease: Surgical Therapy IV1 Apr 2015MP38-18 PROSPECTIVE EVALUATION OF THE SAFETY AND EFFICACY OF SPINAL ANESTHESIA VS. GENERAL ANESTHESIA FOR PERCUTANEOUS NEPHROLITHOTOMY (PCNL) Haresh Thummar, Usama Khater, Rachael Shapiro, Balaji Reddy, and Mantu Gupta Haresh ThummarHaresh Thummar More articles by this author , Usama KhaterUsama Khater More articles by this author , Rachael ShapiroRachael Shapiro More articles by this author , Balaji ReddyBalaji Reddy More articles by this author , and Mantu GuptaMantu Gupta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1393AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES General anesthesia (GA) has been preferred for prone PCNL, but spinal anesthesia (SA) has potentially less morbidity and quicker recovery. A prospective randomized trial was conducted to compare their safety and efficacy METHODS Sixty patients undergoing PCNL were randomized into receiving SA or GA. Bupivacaine 5 mg/ml alone or with the addition of 10 μg of fentanyl was administered in the sitting position into the L2-3 interspace for spinal anesthesia. Patients were placed supine, with Trendelenburg if needed for 10 minutes and sensory and motor blockade confirmed. Intra-operative analgesic supplementation, when deemed necessary, was achieved with intravenous fentanyl boluses (25 μg). GA was induced with standard protocol. Analgesic use, pain visual analogue scores (VAS), OR time, EBL, success rates, complications, and costs were analyzed. RESULTS The sensory and motor blocks after intrathecal bupivacaine and bupivacaine–fentanyl were similar. Sensory block reached the fifth dermatome and deep motor block occurred in all patients. Groups were matched in age, stone burden, and gender (Table 1). There was no significant difference in OR time, EBL, complications, SFR, or difficulty with multiple or upper pole access (Table 2). SA patients required less intra-operative and post-operative analgesia and had better pain scores and less nausea (Table 1, Figure 1). Cost of drugs was lower in SA patients ($20 vs. $200). Two SA patients required supplementation with ketamine for prolonged procedures. CONCLUSIONS SA is as safe, reliable and effective as GA but with less nausea, less analgesic use, better pain scores, and lower cost. SA GA Age 45.6 44.8 Sex (M/F) 43/17 41/19 Side (R/L) 29/23 26/25 Bilateral 8 9 Stone area (mm3) 791.6 798.9 CKD 21 16 Co-morbidity 12 14 Recurrent stone former 21 14 OR time (min) 62.4 64.6 Blood transfusion 3.3% 5.0% Fluoroscopy time 144.6 sec 128.4 sec Stone free rate 93.4% 95% Neurological complication None None SIRS 1 2 Recovery room stay (min) 67.4 158.9 Time to ambulation 7.4 hrs 13.9 hrs Hospital stay 2.1 days 4.1 days Ambulatory PCNL 3 0 Complications/mortality 6.6%/0 8.3%/1 Post op pain* (VAS) (p<0.01) 2.4 5.6 Hemodynamic changes (heart rate, hypotension) 2 4 Nausea* (p<0.002) 2 14 Post op analgesic use* (morphine equivalents) (p<0.0025) 12.0 mg 19.0 mg © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e453 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Haresh Thummar More articles by this author Usama Khater More articles by this author Rachael Shapiro More articles by this author Balaji Reddy More articles by this author Mantu Gupta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...