A randomized study comparing the efficacy and safety of epidural anesthesia versus general anesthesia in patients undergoing percutaneous nephrolithotomy

Abstract

Background Percutaneous nephrolithotomy (PCNL) is the preferred surgical technique for large renal stones (>2 cm in diameter), which involves keyhole surgery through a 1 cm incision on the skin overlying the kidney. It can be performed under local, regional, as well as general anesthesia (GA). We have compared the efficacy and safety of regional epidural anesthesia (EA) and GA in patients undergoing PCNL. Patients and methods In this prospective study, a total of 112 patients of American Society of Anesthesiologists physical status I and II undergoing PCNL were randomized into two groups. Patients in group A (n=56) received regional EA (with lignocaine and bupivacaine), and group B (n=56) patients received standard GA. The postoperative visual analog scale (VAS) score, amount of postoperative analgesic use, adverse effects, operative time, and blood loss were evaluated and compared between the two groups. Results The mean VAS score at 1 h was 1.25 in group A and 5.21 in group B (P<0.001), at 3 h it was 3.05 in group A and 5.04 in group B (P<0.001), and at 6 h it was 3.04 in group A and 4.79 in group B (P<0.001). Less analgesia was required in the EA group compared with the GA group (P<0.001). Five (8.92%) patients in group A and 21 (37.50%) patients in group B had postoperative nausea (P<0.05). Pain score at 18 and 24 h, operative time, postoperative hemoglobin level, and adverse effects were not significantly different between the two groups. Conclusion EA is a good alternative anesthetic technique for PCNL with less analgesic consumption and fewer complications as compared to GA.