Feasibility and Complications of Spinal Anaesthesia in Percutaneous Nephrolithotomy: Our Experience

Percutaneous Nephrolithotomy (PCNL) is the treatment modality used for the extraction of large renal stones, or multiple calculi or stones resistant to shock wave lithotripsy. The General Anaesthesia (GA) is the standard modality for PCNL. However, few studies conclude that Spinal Anaesthesia (SA) can be an alternative method of anaesthesia with similar incidence of complications.

In our study we evaluated the feasibility of spinal anaesthesia in terms of intraoperative and postoperative results in patients undergoing PCNL.

The total 1298 PCNL operations were done for kidney stone from January 2013 to December 2016, out of which 1160 patients underwent PCNL under SA while remaining 138 operations were carried out under GA in the prone position. We retrospectively collected data from the patient's documents. The intraoperative haemodynamic stability was primary objective, and average fall of haemoglobin, postoperative anaesthetic outcome like total tramadol used in first 24 hours, surgical outcome like total clearance of stone burden, patient satisfaction, surgeon satisfaction, need of blood transfusion, conversion to general anaesthesia and pleural puncture were the secondary objectives.

The mean age of the patients was 38.0±17.1 years, and the mean operative time was 80.0±25.9 minutes. The mean calculus size was 30.2±11.8 mm. Return of sensory and motor activity in our study was 150.0±29.2 minutes and 111.0±18.8 minutes, respectively. In first 10 minutes of anaesthesia, 148 (12.75%) patients developed hypotension, which was managed by ephedrine 6 mg intravenously (IV). Total seventy two patients (6.2%) needed blood transfusion and 32 (2.75%) complained of headache, dizziness and low back pain for two to four days after the operation, which improved with analgesics and bed rest. Ninety percent of the patients had complete clearance of calculus or there were no significant residual calculi larger than 5 mm on follow up ultrasonography.

It can be concluded from our study that spinal anaesthesia is the safe and effective method of anaesthesia for PCNL in adult patients.