Spinal-epidural anesthesia versus general anesthesia in the management of percutaneous nephrolithotripsy.
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.
Karacalar
Serap
S
Department of Anesthesiology, Ondokuz Mayis University , Samsun, Turkey. skaracalar@yahoo.com
Bilen
Cenk Yucel
CY
Sarihasan
Binnur
B
Sarikaya
Saban
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D010149:Postoperative Pain / Q000517:prevention & control; D055815:Young Adult