[Comparison of efficacy and complications general versus spinal anesthesia in PCNL]

ABSTRACT

Complication of general anesthesia, especially during change of position, is more than spinal anesthesia. We evaluated our experience regarding spinal anesthesia in comparison to general anesthesia in patients older than 18 years old that were candidate for PCNL. In this randomized clinical trial study, from March 2008 to February 2010, 110 patients older than 18 years who were candidate for PCNL, after informing them and getting their approval, they were randomly assigned into two groups by Zelen randomization method. Then, in group 1, general anesthesia was induced by parental and inhalational drugs as standard methods and PCNI was performed in prone position under fluoroscopy guidance by standard technique. In group 2, spinal anesthesia was done by spinal needle NO 23-25 gauge and injecting 2-3 ml of Bupivacaine and 0.5 ml Fentanyl in spinal space L4 in sitting position. Then urethral catheter was inserted in lithotomic position and head of bed tilted down for 5-10 minutes with checking level of anesthesia. Then, the patients were rotated easily by the help of in prone position and PCNL were done under guide of fluoroscopy by standard technique and results with complications were recorded and analyzed by SPSS software and chi-square and T student test. Mean stone size in group one and two were 34.2 +/- 9.8 and 31.3 +/- 7.9 millimeters respectively. Considering efficacy and successfulness of operation, clearance of system from stones or residual stones<5 millimeter was respectively 80 and 72.73 percent in groups 1 and 2 [p=.37. There were no major Intra-operative or postoperative complications such as visceral or vascular injury and unusual bleeding in our patients. Need to narcotic drugs in operative day [D0] in groups 1 and 2 were 12.4 +/- 3.1 and 7.8 +/- 2.3 milligram equivalent to morphine sulphate [p=0.3]. The coast of anesthetic drugs in groups 1 and 2 were 23 +/- 3.7 and 4.5 +/- 1.3$ respectively [p=.001]. Spinal anesthesia with combined Bupivacaine and Fentanyl is safe, effective, and also a comfortable method for performing PCNL and is a good alternative for general anesthesia in adult patients with low coast