Turki Sonali, Mir Shafat Ahmad, Sofi Khalid P, Khan Nadeem, Khawaja Rouf, Wani Mohammad S
Department of Anaesthesia, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
Department of Urology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
Anesth Essays Res. 2021 Jul-Sep;15(3):306-311. doi: 10.4103/aer.aer_124_21. Epub 2022 Feb 14.
There has been considerable debate regarding the ideal anaesthetic technique for Percutaneous Nephrolithotomy (PCNL). PCNL is usually performed under general anaesthesia (GA) in prone position. The prone position under GA is associated with various complications. To address these complications, our study was carried out to determine whether epidural anaesthesia [EA] with dexmedetomidine sedation can be a better alternative to GA for PCNL.
To compare the efficacy and feasibility of performing PCNL under EA in combination with dexmedetomidine infusion.
Out of 225 patients observed in this study, 115 patients (group A) underwent PCNL under EA with dexmedetomidine infusion and 110 patients (group B) underwent PCNL under GA.
Mean time to the first dose of rescue analgesia was significantly increased in Epidural group (328.17 ± 63.74) compared to GA group (72.09 min, p < .0001) and the mean Visual analog scale [VAS] scores were significantly lower in epidural compared to GA group at different time intervals during the first 24 h after surgery (p<0.05). Patients in epidural group had significantly less post-operative nausea, vomiting (6.1 % vs 13.6 %), and significantly less shivering (12.2% vs 33.6%). Mean patient satisfaction score in epidural group was significantly higher (8.75 ± 1.29 vs 8.14 ± 1.39, p=0.001); however, the mean surgeon satisfaction score was comparable among the two groups (8.76 ± 1.39 in Group A and 8.61 ± 1.35 in Group B, p=0.421).
Our study shows that EA is an equally effective alternative to GA for PCNL, with more patient satisfaction, less postoperative pain, early ambulation and postoperative recovery, less systemic analgesic requirements and less adverse effects.
关于经皮肾镜取石术（PCNL）的理想麻醉技术一直存在相当多的争论。PCNL通常在全身麻醉（GA）下于俯卧位进行。全身麻醉下的俯卧位与各种并发症相关。为解决这些并发症，我们开展了这项研究，以确定右美托咪定镇静的硬膜外麻醉（EA）是否可作为PCNL替代全身麻醉的更好选择。
比较在EA联合右美托咪定输注下进行PCNL的疗效和可行性。
在本研究观察的225例患者中，115例患者（A组）在EA联合右美托咪定输注下接受PCNL，110例患者（B组）在全身麻醉下接受PCNL。
与全身麻醉组（72.09分钟，p <.0001）相比，硬膜外组首次使用解救镇痛药物的平均时间显著延长（328.17±63.74），并且在术后24小时内的不同时间间隔，硬膜外组的平均视觉模拟量表（VAS）评分显著低于全身麻醉组（p <0.05）。硬膜外组患者术后恶心、呕吐明显较少（6.1%对13.6%），寒战也明显较少（12.2%对33.6%）。硬膜外组患者的平均满意度评分显著更高（8.75±1.29对8.14±1.39，p = 0.001）；然而，两组外科医生的平均满意度评分相当（A组为8.76±1.39，B组为8.61±1.35，p = 0.421）。
我们的研究表明，对于PCNL，EA是替代GA的同样有效的选择，患者满意度更高，术后疼痛更少，能早期活动和术后恢复，全身镇痛需求更少，不良反应也更少。
