Percutaneous Nephrolithotomy under Spinal Anesthesia with Marcaine

Introduction & The efficacy of Percutaneous Nephrolithotomy (PCNL) in the treatment of renal stones has been proven in its indications. The main method of anesthesia in this procedure is general anesthesia. We used spinal anesthesia (SA) as an alternative method of anesthesia with many benefits. This study was intended to show the possibility of SA as a more comfortable method of anesthesia for the surgeon, the anesthesiologist and the patient via more cooperation of the patient during changing the position and prevention of some complications mostly in upper extremities and neck. In a prospective clinical trial study, a total of 112 patients underwent PCNL under SA with marcaine, from Nov 2004 till Feb 2009. Their mean age was 36 years (22-48), at first the syringe was stained by epinephrine and then 2 -3.5 ml marcaine was used for SA and addition of analgesics, sedatives or both., if needed. The rest of the procedure was done as routine. Stone clearance was achieved in 82% of the patients and the rest were managed by ESWL. The mean operation time was 126 minutes (90-220), 36% of the patients needed sedation, analgesia, or both, specially those with bigger stones. 6% of the patients had upper pole stones. Blood transfusion was needed only in one patient. No significant complication was observed in this study. PCNL under SA afforded the surgeon and the anesthesiologist the opportunity of more patient cooperation during position changes and precludes some morbidities that may happen under general anesthesia because the patient is awake and able to portend.