title: "Ambulatory PCNL" (tubeless PCNL under regional anesthesia) -- a preliminary report of 10 cases.
abstract: OBJECTIVE
  We report the technique, safety, outcome and efficacy of "tubeless percutaneous nephrolithotomy (PCNL) performed under regional anesthesia" in selected cases.
  
  
  METHODS
  Patients satisfying the entry criteria for the regional block (spinal low-dose anesthesia with low-dose Bupivacaine plus Fentanyl) and tubeless procedure were subjected to a tubeless spinal PCNL The patients were followed up the next day for an ultrasonography and an x-ray of the KUB region.
  
  
  RESULTS
  All the ten patients were discharged uneventfully the next day (mean hospital stay-40 h). No blood transfusion and postoperative analgesics (mean post op visual analogue pain score was 2.4) were required. The mean time to return of S(1) sensation, motor block and walking were 183,118 and 196.6 min respectively. There was complete stone clearance in all the cases with a mean collection of 14.5 cc was seen on the post op ultrasound.
  
  
  CONCLUSIONS
  The present cases were reported to highlight that in a select group of patients tubeless PCNL under regional block is technically feasible and viable option. Regional block has the advantage of avoidance of general anesthesia and anaphylaxis due to use of multiple drugs. Tubeless PCNL has the advantage of avoidance of nephrostomy tube related postoperative pain discomfort and urosepsis. This synergistically (spinal + tubeless PCNL) speeds up the recovery, shortens the length of hospitalization and the analgesic requirement.
authors.affiliation: Division of Urology, Department of Surgery and Anesthesiology, University College of Medical Sciences, University of Delhi, Delhi-95, India. iqbalsinghp@yahoo.co.uk
authors.forename: Iqbal
authors.initials: I
authors.lastname: Singh
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
authors.forename: Praveen
authors.initials: P
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D000765:Anesthesia, Conduction; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D007902:Length of Stay; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*