Feasibility of percutaneous nephrolithotomy under assisted local anaesthesia: a prospective study on selected patients with upper urinary tract obstruction.
OBJECTIVE
To evaluate the feasibility of performing percutaneous nephrolithotomy (PCNL) under local anaesthesia in selected patients.


METHODS
Twenty-four patients with unilateral renal obstruction due to pelvic stones > or =2.0 cm were enrolled in our study. First a percutaneous nephrostomy to decompress the obstructed kidney was performed using local anaesthesia (lignocaine). A 16-Fr nephrostomy tube was left in place for 1 wk, and then the second stage was carried out. After having infiltrated the tract and the renal parenchyma with lignocaine, dilatation of the nephrostomy tract was performed. Subsequently, PCNL was done using a 24-Fr rigid nephroscope and a ballistic lithotripter. All patients were premedicated with pethidine HCl intramuscularly 30 min before the beginning of both stages. Diazepam was given (0.1mg/kg orally) to patients before the second stage. Pain scores were collected using 10-cm linear visual analogue scale (VAS) after the completion of both procedures.


RESULTS
The procedure was well tolerated. One patient needed further treatment with midazolam during PCNL. The mean VAS score was 38 mm (range: 17-60 mm) for the first stage and 36 mm (13-69 mm) for the second stage. The mean operative time, including both stages, was 127 min (85-155 min). No anaesthesia-related complications occurred.


CONCLUSIONS
Our study indicates that PCNL under assisted local anaesthesia is safe and effective in selected patients.
Aravantinos
Evangelos
E
Department of Urology, University Hospital of Larissa, Feidiou 6-8, 412 21 Larissa, Greece.
Karatzas
Anastasios
A
Gravas
Stavros
S
Tzortzis
Vassilios
V
Melekos
Michael
M
D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D000779:Anesthetics, Local; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000150:complications / Q000628:therapy*; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D010147:Pain Measurement; D014517:Ureteral Obstruction / Q000209:etiology
D000779:Anesthetics, Local