A Randomized Study Comparing Effectivity and Safety of Spinal Anesthesia Versus General Anesthesia in Patients Undergoing Percutaneous Nephrolithotomy (PCNL)

Context Comparision of two anesthesia in Percutaneous Nephrolithotomy surgeries. Background and Aims PCNL can be performed under general anesthesia, regional anesthesia or local anesthesia. Recently, PCNL under spinal anesthesia was reported as having some advantage over general anesthesia, such as lower post operative pain, lower dose requirement for analgesic drugs and avoidance of the side effects from multiple medication during general anesthesia. The aim of this study was to compare the efficacy and safety of regional spinal anesthesia (SA) and general anesthesia (GA) in patients who underwent PCNL. Methods A hospital based, randomized and comparative study was performed in total100 patients divided into 2 groups of 50 each. Group A received GA. Group B received spinal isobaric levobupivacaine (0.5 %) 3.5ml. Sample size was calculated at 80 % study power, level 0.05 assuming difference in mean to be detected 12.9+_21.1. Results There was no significant difference in systolic blood pressure, diastolic blood pressure and mean blood pressure preoperatively and significant difference thereafter between the groups. Post operative average pain score at 2hr, 3hr and 6hr was showing highly significant difference between GA and SA groups (P value less than0.001). There was highly significant difference in Mean tramadol requirement within 24 hours which was lower in spinal group (79.0 28.7mg) than of general anesthesia group (125.0 43.2 mg). There was statistically no significant difference in adverse effects like hypotension, bradycardia in both groups except nausea. Conclusion The advantages of spinal anesthesia over general anesthesia are less postoperative pain, analgesic usage, nausea/vomiting and adverse effects from medication.