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

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.