Haydarpasa Numune Med J. 2016; 56(3): 181-185

Comparison of Spinal Versus General Anesthesia in Percutaneous Nephrolithotomy

Eyüp Veli Küçük, Ümit Yýldýrým, Ahmet Bindayý, Ahmet Tahra, Fikret Fatih Önol
Department of Urology, Ümraniye Training and Research Hospital, Ýstanbul, Turkey

INTRODUCTION: To compare the efficacy and safety of spinal anesthesia and general anesthesia in percutaneous nephrolithotomy (PCNL) operation.
METHODS: Between 2012 and 2015, 316 patients with kidney stones were treated with PCNL and evaluated retrospectively. Group 1 (n = 206) underwent general anesthesia and group 2 (n = 110) underwent spinal anesthesia. In group 1, PCNL was performed using standard technique under general anesthesia. In group 2, spinal anesthesia was done by injecting bupivacaine and fentanyl in spinal space between lumbar vertebra 3 and 4 in sitting position. Thereafter, a ureteral catheter was placed in lithotomy position following the checking of level of anesthesia. Then, PCNL was done by standard technique. Complications were recorded and analyzed.
RESULTS: Mean stone size in group 1 and 2 was 32.2 ± 8.6 mm and 31.5 ± 8.2 mm, respectively. Operation time and decrease in hemoglobin level were similar between group 1 and group 2 (83.4 min vs 86 min, p= 0.31 and 0.9 g/dl vs 1 g/dl, p= 0.27, respectively). Intra-operative hypotension and postoperative headache were seen more in spinal group than the general anesthesia group with a statistically significant difference (P < 0.05). No neurologic complications were observed in both groups. Need to narcotic medications after the operation were 11.3 ± 3.1 mg and 7.6 ± 2.5 mg of morphine sulphate in group 1 and 2, respectively (P = 0.03).
DISCUSSION AND CONCLUSION: Spinal anesthesia with combined bupivacaine and fentanyl is a safe and effective anesthetic method and had a comparable results
regarding for PCNL.

Keywords: Percutaneous nephrolithotomy, general anesthesia, spinal anesthesia

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Perkütan Nefrolitotomide Spinal ile Genel Anestezi Yöntemlerinin Karþýlaþtýrýlmasý

Eyüp Veli Küçük, Ümit Yýldýrým, Ahmet Bindayý, Ahmet Tahra, Fikret Fatih Önol
Ümraniye Eðitim ve Araþtýrma Hastanesi, Üroloji Kliniði, Ýstanbul

GÝRÝÞ ve AMAÇ: Perkütan nefrolitotomi(PNL) operasyonunda spinal ile genel anestezi yöntemlerinin etkinlik ve güvenirliliklerinin karþýlaþtýrýlmasý.
YÖNTEM ve GEREÇLER: 2012-2015 yýllarý arasýnda böbrek taþý nedeniyle PNL uygulanan 316 hasta restrospektif olarak deðerlendirldi. Genel anestezi grubunda 206 hasta (grup 1), Spinal anestezi grubunda 110 (grup 2) hasta mevcut idi. Grup 1’de standart genel anestezi uygulanýrken, Grup 2’de bulunan hastalara L3-4 spinal aralýklarýnda oturur pozisyonda bupivakain ve fentanil enjeksiyonu uygulandý. Litotomi pozisyonunda
spinal anestezi seviyesi belirlendikten sonra üreteral kateter yerleþtirildi ve standart PNL operasyonu uygulandý. Komplikasyonlar
kayýt edildi ve analiz retrospektif olarak gerçekleþtirildi.
BULGULAR: Ortalama taþ boyutu grup 1’de 32.2 ± 8.6 mm iken grup 2’de 31.5 ± 8.2 mm idi. Operasyon süresi ve hemoglobin seviyesindeki düþüþ grup 1 ve grup 2 arasýnda benzer olarak bulundu (83.4 dk ile 86 dk, p= 0.31 ve 0.9 g/dl ile 1 g/dl, p=0.27). Ýntraoperatif hipotansiyon
ve postoperatif baþ ve sýrt aðrýsý spinal anestezi grubunda istatisktiksel olarak daha fazla idi (p<0.5). Her iki grupta da nörolojik komplikasyon tesbit edilmedi. Narkotik analjezik ihtiyacý grup 1’de 11.3 ± 3.1 mg iken grup 2’de 7.6 ± 2.5 mg morfin sülfat olarak tesbit edildi(p= 0.03).
TARTIÞMA ve SONUÇ: Bupivakain ve fentanil ile kombine spinal anestezi yöntemi ile PNL operasyonu, genel anestezi ile PNL’ye benzer sonuçlarý ile etkin ve
güvenilir bir yöntemdir.

Anahtar Kelimeler: Perkütan nefrolitotomi, genel anestezi, spinal anestezi

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