Spinal-epidural anesthesia versus general anesthesia in the management of percutaneous nephrolithotripsy.

ABSTRACT

OBJECTIVE: To compare the efficacy between combined spinal-epidural block and general anesthesia in patients undergoing percutaneous nephrolithotripsy (PNL). METHODS: A total of 180 patients undergoing PNL were randomly allocated to receive spinal-epidural anesthesia plus intravenous patient-controlled anesthesia with tramadol or general anesthesia (propofol induction, maintenance with sevoflurane) plus intravenous patient-controlled anesthesia with tramadol (G group). Hemodynamic changes, postanesthesia care unit (PACU) discharge times, times to home readiness, side effects, patient and endoscopist satisfaction, postoperative pain (scored from 0 to 10 on a visual analog scale), and analgesic medication were recorded. RESULTS: Rates of hypotension (p = 0.06) and bradycardia (p = 0.14) did not differ between the groups. Compared with the G group, duration of PACU and the time to home readiness (p = 0.001 for each) were shorter in the spinal-epidural group. The incidence of nausea was higher in the G group (p = 0.001); vomiting and pruritus rates were similar between groups. No patient had respiratory depression. The spinal-epidural group had better patient satisfaction (p = 0.001) and lower pain scores (p = 0.001). The G group required more diclofenac during the first 48 h (p = 0.001). CONCLUSIONS: In patients undergoing PNL, spinal-epidural anesthesia and analgesia gave greater patient satisfaction, shorter times for PACU and home readiness, and less postoperative pain. Spinal-epidural anesthesia is an attractive alternative to general anesthesia in these patients.