title: Effect of single-dose subarachnoid spinal anesthesia on pain and recovery after unilateral percutaneous nephrolithotomy.
abstract: OBJECTIVE
  We studied the impact of one dose of subarachnoid spinal analgesia on postoperative pain and recovery after percutaneous nephrolithotomy (PCNL).
  
  
  METHODS
  Between August 1999 and May 2000, 20 PCNL patients were randomized into two groups: Group A (N = 9), who received preoperative subarachnoid spinal analgesia with morphine sulfate, and Group B (N = 11), who received no subarachnoid spinal analgesia. Both groups were given general anesthesia, and the nephrostomy site was infiltrated with bupivacaine hydrochloride. Stone size was similar in the two groups, as were ASA classification, age, and body mass index. Pain analog scales (maximum score 10) were completed preoperatively and on the day of surgery (D0), after 1 day (D1), and after 2 days (D2). The amount of morphine sulfate equivalents (MS eq) needed, the activity level, and adverse effects were recorded.
  
  
  RESULTS
  In Group A, the average pain score on D0, D1, and D2 was 2.7, 3.7, and 1.4, respectively; in Group B, the average pain score was 4, 4.5, and 2, respectively (P > 0.05). The average MS eq used in Groups A and B were 8.3 v 33.8 (P = 0.002) on D0; 17.7 v 28.7 (P > 0.05) on D1; and 11.1 v 10.1 (P > 0.05) on D2. On D0, in Group A, 56% of the patients were ambulating and 11% complained of nausea, while in Group B, 0 were ambulating and 46% complained of nausea.
  
  
  CONCLUSIONS
  A single preoperative dose of subarachnoid spinal analgesia provides a statistically significant decrease in postoperative parenteral pain medication and earlier ambulation. It also appears to reduce the amount of postoperative pain and decrease nausea.
authors.affiliation: Department of Surgery/Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Cassio
authors.initials: C
authors.lastname: Andreoni
authors.forename: Ephrem O
authors.initials: EO
authors.lastname: Olweny
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Portis
authors.forename: Chandru P
authors.initials: CP
authors.lastname: Sundaram
authors.forename: Terri
authors.initials: T
authors.lastname: Monk
authors.forename: Ralph V
authors.initials: RV
authors.lastname: Clayman
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000762:Anesthesia Recovery Period; D000775:Anesthesia, Spinal; D004305:Dose-Response Relationship, Drug; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011183:Postoperative Complications; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D011229:Preanesthetic Medication; D001261:Pulmonary Atelectasis / Q000209:etiology; D024162:Second-Look Surgery; D013346:Subarachnoid Space
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine