General versus spinal anesthesia in percutaneous nephrolithotomy: A comparative study

Background: Percutaneous nephrolithotomy (PCNL) is usually done under general anesthesia (GA). However, it can be done under spinal anesthesia (SA) which can have advantages like less bleeding, less postoperative pain, low dose analgesic requirement and less drug intake. Aim: In our study, we had compared the efficacy and safety of general versus Spinal Anaesthesia in PCNL. Materials and methods: In prospective randomized study, 100 patients undergoing PCNL were randomly assigned into two groups; group A (n = 50) underwent PCNL under GA, by injecting thiopentone, succinylcholine and vecuronium and group B (n = 50) received SA, by injecting bupivacaine and fentanyl in spinal space L4 in sitting position. Thereafter, a urethral catheter was placed in lithotomy position, head of the table was tilted down for 5 to 10 minutes, and the level of anesthesia was checked. Then, PCNL was done by standard technique. Results: Hemodynamic stability was more in SA group. Heart rate and mean arterial pressure intraoperatively at 5, 10, 15 mins and at 60 mins and postoperatively at 0, 2 and 6 hours was significantly less in SA group (P < 0.05) as compared to GA group. The VAS score was 5.29±0.62 in GA group and 0.98±0.89 in SA group at 0 hour, 5.58±0.49 in GA group and 1.88±0.84 in SA group at 2 hours and 4.26±1.30 in GA group and 2.10±1.02 in SA group at 6 hours which was significantly lower in SA group in comparison with GA group (P < 0.05). Mean analgesic requirement within 24 hours was lower in SA group (76±36.05) than GA group (140±28.57) and it was statistically highly significant (p<0.001). Postoperative nausea and vomiting was more in GA group than SA group. Conclusion: Spinal anaesthesia is a safe alternative to GA for PCNL with better pain relief, less analgesic requirement, less side effects.