title: Percutaneous nephrolithotomy under local infiltration anesthesia: a single-center experience of 2000 Chinese cases.
abstract: OBJECTIVE
  To determine the feasibility and safety of percutaneous nephrolithotomy (PCNL) in treating upper urinary calculi under local infiltration anesthesia.
  
  
  METHODS
  A series of 2000 patients with upper urinary calculi underwent PCNL under local infiltration anesthesia. Of the 2000 patients, 536 had upper ureteral calculi, 805 patients had pelvic calculi, and 659 patients had complex renal calculi. Pethidine premedication (75-100 mg) and Phenergan (25 mg) were used half an hour preoperatively. The mean pain scores at 0, 6, 24, and 48 hours postoperatively, the demographic characteristics, and the stones characteristics were evaluated to determine the feasibility. The complications were evaluated to determine the safety, and stone-free rate was evaluated to determine effectivity.
  
  
  RESULTS
  The mean American Society of Anesthesiologists score was 1.55 ± 0.54 (range, 1-3). The mean operative time was 48 minutes (range, 20-125). The mean Visual Analogue Scale scores at 0, 6, 24, and 48 hours postoperatively were 3.62, 3.02, 2.27, and 2.09, respectively. The mean hemoglobin drop was 1.06 g/dL (range, 0.2-6.8). Sixty-five patients (3.3%) received transfusions, 10 patients (0.5%) required selective renal angioembolism (Clavien grade II), and 1 patient (0.05%) received chest drainage therapy (Clavien grade II). The total stone-free rate was 85.8%.
  
  
  CONCLUSIONS
  Local infiltration anesthesia is a well-tolerated alternative anesthesia technique that provides effective intraoperative and postoperative analgesia for PCNL. PCNL performed under local infiltration anesthesia in a selected group of patients is feasible and provides satisfactory clinical outcomes. Comparative studies should be performed to classify efficacy, safety, tract quantity, dilation method, and the best candidates.
authors.affiliation: Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
authors.forename: Hulin
authors.initials: H
authors.lastname: Li
authors.forename: Kai
authors.initials: K
authors.lastname: Xu
authors.forename: Bingkun
authors.initials: B
authors.lastname: Li
authors.forename: Binshen
authors.initials: B
authors.lastname: Chen
authors.forename: Abai
authors.initials: A
authors.lastname: Xu
authors.forename: Yuanbo
authors.initials: Y
authors.lastname: Chen
authors.forename: Yawen
authors.initials: Y
authors.lastname: Xu
authors.forename: Yong
authors.initials: Y
authors.lastname: Wen
authors.forename: Shaobo
authors.initials: S
authors.lastname: Zheng
authors.forename: Chunxiao
authors.initials: C
authors.lastname: Liu
mesh_terms: D000759:Adjuvants, Anesthesia / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D002681:China; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008614:Meperidine / Q000627:therapeutic use; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy; D011398:Promethazine / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014545:Urinary Calculi / Q000601:surgery*
chemical_list: D000759:Adjuvants, Anesthesia; D008614:Meperidine; D011398:Promethazine