title: Comparison of percutaneous nephrolithotomy under spinal versus general anesthesia: a randomized clinical trial.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of spinal anesthesia compared with general anesthesia in patients who underwent percutaneous nephrolithotomy (PCNL).
  
  
  METHODS
  One hundred patients with American Society of Anesthesiologists (ASA) score <3 were randomly divided into two groups according to the type of anesthesia. Spinal anesthesia was performed using an injection of 0.25 mg/kg bupivacaine 0.5% in the intrathecal space; no opium (fentanyl) agent was used. All procedures were performed with the patient in the prone position. Stone access was made by using fluoroscopic guidance, and the tract was dilated using a single-stage technique. All patients received a solution including 1 mg/kg morphine in every 100 mL physiologic saline through the volumetric pump during the 3-hour post-PCNL period in the recovery room. Afterward, morphine (0.05 mg/kg) was injected only according to the verbal rating scale greater than 3 after discharge from the recovery room until 24 hours after surgery.
  
  
  RESULTS
  The two groups were matched by mean age, distribution of stone location, and stone burden. Mean operative time, hospital stay, stone-free rate and mean hemoglobin drop were comparable between the two groups. The rate of complications according to the Clavien grading system was nearly similar in both groups. Mean analgesic requirement during 24 hours after PCNL was 6.8 mg in the spinal group and 13.2 mg in the general group (P<0.001).
  
  
  CONCLUSIONS
  It seems that using spinal anesthesia by intrathecal injection of local anesthetic solutions vs general anesthesia has comparable surgical outcomes and reduces the requirement for analgesia after PCNL in the early postoperative period.
authors.affiliation: Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, IR Iran.
authors.forename: Akbar
authors.initials: A
authors.lastname: Nouralizadeh
authors.forename: Seyed Amir Mohsen
authors.initials: SA
authors.lastname: Ziaee
authors.forename: Seyed Hossein
authors.initials: SH
authors.lastname: Hosseini Sharifi
authors.forename: Abbas
authors.initials: A
authors.lastname: Basiri
authors.forename: Ali
authors.initials: A
authors.lastname: Tabibi
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Sharifiaghdas
authors.forename: Hossein
authors.initials: H
authors.lastname: Kilani
authors.forename: Babak
authors.initials: B
authors.lastname: Gharaei
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Roodneshin
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Soltani
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007278:Injections, Spinal; D007669:Kidney Calculi / Q000601:surgery*; D007902:Length of Stay / Q000639:trends; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D061646:Operative Time; D011184:Postoperative Period; D016684:Prone Position; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine