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INTRODUCTION: PCNL has revolutionized the treatment of renal calculi putting almost an end to the era of open stone surgery. The procedure can safely be carried out under general anesthesia (GA) or regional anesthesia viz. spinal anesthesia (SA), epidural anesthesia (EA) or combined spinal and epidural anesthesia (CSE). AIMS AND OBJECTIVES: We evaluated the surgical outcome after PCNL in two groups of patients randomly divided to undergo procedure under GA or EA. PATIENTS AND METHODS: Two hundred and thirty patients with American Society of Anesthesiologists (ASA) score <3 were randomly divided into two groups according to the type of anesthesia: i.e. GA (n=110) or EA (n=120). All patients underwent PCNL in prone position. Puncture was done using Bulls eye technique under fluoroscopic guidance and tract dilated using serial dilators up to 24Fr-28 Fr. Demographics, perioperative and postoperative parameters were noted and data analysed. RESULTS: The two groups were comparable in terms of mean age, distribution of stone location, and stone burden. The stone free rate was 90.9% in GA group and 89.2% in EA group and the difference was statistically insignificant (P= 0.659). The requirement for auxiliary procedures was similar between the two groups. A significant difference in pain score was seen in favor of EA group during early post-operative period (P< 0.05). CONCLUSION: It seems that PCNL can be performed safely and effectively under regional epidural anesthesia with results comparable to general anesthesia with the added advantage of less immediate postoperative pain and analgesic requirement.
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BACKGROUND: Obturator nerve (ON) stimulation during transurethral resection of lateral and posterolateral bladder wall tumor under spinal anesthesia may lead to obturator reflex, adductor contraction, and leg jerking with complications such as bleeding, bladder perforation, or incomplete tumor resection. Our study was carried out to obtain successful block of ON using ultrasound (US)-guided technique with or without nerve stimulation in patients undergoing transurethral resection of bladder tumor (TURBT) under spinal anesthesia. AIMS: The aim of the study was to compare the effectiveness of two different techniques in blocking ON and adductor spasm during TURBT. SETTINGS AND DESIGN: Prospective, randomized, double-blind study. SUBJECTS AND METHODS: Sixty patients with American Society of Anesthesiologists Status II and III scheduled to undergo TURBT for lateral and posterolateral bladder wall tumor were enrolled. Group I (US group, n = 30) patients received 5 ml of bupivacaine 0.5% each at anterior, and posterior division of ON under real-time US visualization and Group II (US-NS group, n = 30) received the same amount of bupivacaine 0.5% for each division using US-guidance with nerve stimulation-assisted technique. Motor block onset time, block success and performance time, ease of performance of block, and complications were measured besides assessing patient and surgeon satisfaction into two groups. STATISTICAL METHODS USED: SPSS using two sample independent t-test and Pearson's Chi-square/Fisher's exact test. RESULTS: Motor block onset was significantly faster in Group II (6.67 ± 2.40) than in Group I (12.39 ± 2.55). A success rate of 90% was achieved in Group II as compared to 76.7% in Group I with increased block performance time in Group II (4.47 ± 0.73 min) versus (2.10 ± 0.51 min) in Group I. A better patient and surgeon satisfaction were seen in Group II with combination of US and nerve stimulation technique. No complications were encountered. CONCLUSION: We conclude that both techniques are safe and easy to perform; however, nerve stimulation as an adjunct to US results in a faster onset of block with a higher success rate.