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Indian Journal of Anesthesia and Analgesia

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A Critical Evaluation of Safety and Efficacy of Spinal Anesthesia in Comparison with General Anesthesia in Percutaneous Nephrolithotomy

Anbu Muruga Raj Annamalai, Assistant Professor, Department of Anesthesiology, Melmaruvathur Adhiparasakthi Institute of Medical sciences and Research, Melmaruvathur, Kancheepuram District, Tamilnadu 603319, India , Prasath Chandran1 , Anbu Muruga Raj Annamalai2

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Indian Journal of Anesthesia and Analgesia 5(11):p 1952-1957, November-December 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.51118.27

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Abstract

  Context: Percutaneous nephrolithotomy (PCNL) under general anesthesia plays a major role in larger size kidney stones, but  in many times spinal anesthesia will be more advantageous owing to better hemodynamic stability and also equally effective in relieving pain. Aim: The aim of this current study is to compare the safety and effectiveness of spinal anesthesia with general anesthesia in percutaneous nephrolithotomy. Settings and Design: It is a randomized prospective study done in MelmaruvathurAdhiparasakthi Institute of Medical sciences and research from April 2016 to April 2018. Methods and Material: 100 patients who were undergoing PCNL were randomly selected and divided into two groups. Group SA (n=50) received total dose 3.4 ml of 0.5% hyperbaric Bupivacaine with 0.6mg of Nalbuphine. Group GA (n=50) received premedication with Glycopyrolate and Fentanyl and they were anesthetised with Propofol and Succcinylcholine Anesthesia was maintained with Vecuronium and N 2O/O2/Isoflurane. Heart rate, mean arterial blood pressure and complications like hypotension, bradycardia were recorded
intraoperatively and postoperatively. Statistical analysis used: Statistical analysis were calculated with the graph pad prism 5.0 software. The data were expressed as a mean and standard deviation.All the quatitative variables were analysed using Unpaired t­test. Results: Pulse rate at 5, 10, 45, 60 minutesintra operatively and at 0, 3, 5 hours postoperatively were significantly less in patients receiving spinal anesthesia group when compared to general anesthesia group (p<0.0001). Mean arterial pressure at 5, 10, 15, 20, 25, 30, 45, 60 minutes intra operatively and at 0, 3, 5 hours postoperatively was found to be less in spinal anesthesia group then the GA group (p< 0.0001). The VAS score at 0, 3, 5, 8 hours was found to be less and statistically significant in spinal anesthesia group as compared to general anaesthsia group (0.66±0.51/4.14±0.75, 1.38±0.49/5.4±0.61, 1.8±0.45/4.32±0.47, 3.78±0.58/4.34±0.47). Moreover analgesic requirement of tramadol more than 100mg was lower in SA group than GA group. Conclusions: Our study shows that spinal anesthesia for PCNL is relativelysafe and equally effective alternative to general
anesthesia with better hemodynamic stability, lower postoperative pain, minimal analgesic requirements, and early recovery. 

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.51118.27

Keywords

PCNL; Spinal Anesthesia; VAS Score; General Anesthesia; HemodynamicsAnalgesia. 

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