Different Regional Anesthesia Techniques for Supine Percutaneous Nephrolithotripsy

Background: With the introduction of new technologies in endourology, supine percutaneous nephrolithotripsy (sPCNL) is becoming a trend as it has numerous benefits in terms of safety, efficacy, and versatility. It allows anesthetists the privilege of using regional anesthesia with its advantages over general anesthesia for this procedure; as regional anesthesia lowers morbidity, analgesic requirements and the duration of hospital stay. In our study we compared two regional anesthesia techniques; continuous spinal anesthesia (CSA) versus combined spinal epidural anesthesia (CSE) for patients undergoing sPCNL. The aim of this study is to highline the most appropriate anesthesia technique in both quality and efficacy for sPCNL. Methods: A total of forty patients were randomly allocated to receive either CSA with a standard epidural set (Touhy needle18-G, catheter 20-G) or CSE using needle through needle technique. Demographic data, time taken for catheter insertion, difficulty of technique, the occurrence of hypotension, the total dose of ephedrine, the occurrence of post dural puncture headache (PDPH), highest level of sensory blockade, quality of motor blockade and the duration of the surgical procedure were all recorded. Results: Patient characteristics in the two groups were similar; age, weight, height and duration of surgery. Only 3 patients in CSA were excluded and 2 in CSE for technical difficulties. The time taken for performing the blockade was shorter in CSA (2.5 ±0.9min) than in CSE (3 ± 1.1min). The highest sensory level in CSA was T7 (range: T5-T8) and T5 in CSE (range: T4-T7). Motor blockade was similar in the two groups. No significant differences in the supplementary doses needed in re-lation to time, analgesia level or blockade quality. Arterial hypotension was found in 3 patients in CSA and in 5 patients in CSE, more often in CSE and a significantly higher dose of ephedrine 16.2 ± 17mg in CSE than 10.5± 15mg in CSA. And a higher incidence of PDPH in 4 patients from CSA compared to 2 in CSE. Conclusion: From our study we found that both CSA and CSE are effective and safe techniques for PCNL in the supine position. CSA provided better cardiovascular stability. CSA is an attractive alternative to CSE in supine PCNL especially for critical patients with limited cardiac or respiratory reserve. Correspondence to: Dr. Amira R. Hassan, The Department of Anesthesia, Faculty of Medicine, Cairo University.