Gupta Rahul, Khan Suhail M, Gupta Sunana, Mahajan Arti, Sharma Chetan, Gupta Chaman Lal
Urology, Government Medical College, Jammu, Jammu, IND.
Anesthesia and Critical Care, All India Institute of Medical Sciences, Jammu, Jammu, IND.
Cureus. 2023 May 3;15(5):e38472. doi: 10.7759/cureus.38472. eCollection 2023 May.
Introduction Percutaneous nephrolithotomy (PCNL) procedure has evolved over the years and one such evolution has been the introduction of supine PCNL by Valdivia in 1987. This approach offers the added advantage of safe access in patients with compromised cardiovascular and pulmonary function. General anesthesia is the preferred anesthetic technique for PCNL. However, in the last decade, there has been an increase in the usage of regional anesthesia for this procedure. We share our experience of supine PCNL for solitary renal pelvic stones under regional anesthesia. Aim and objective To assess the feasibility, safety, and efficacy of supine PCNL for solitary renal pelvic stones sized 1.5 to 3 cm under spinal anesthesia. Material and methods This was a retrospective record review of 35 patients (21 male) who underwent supine PCNL under regional anesthesia between January 2022 till December 2022 at our institute. All patients had a solitary renal pelvic calculus sized 1.5-3 cm. Intraoperative and postoperative data were analyzed. Results The mean age of patients was 38.5 ± 15 years. The postoperative pain visual analog scale (VAS) score was <5 in 31 (89%) and >5 in 4 (11%) patients. The mean hospital stay was 3.33 ± 0.88 days. Mean fall in hemoglobin level was 0.49 ± 0.43 mg/dL. Postoperatively, mild hematuria occurred in three patients (8.5%) and fever occurred in two (5.7%) patients. There was no injury to adjacent organs in this series. Blood transfusion was required only in one patient. Complete stone clearance was achieved in all patients. Conclusion In experienced hands, supine PCNL under regional anesthesia is a feasible, safe, and effective approach with minimal morbidity.
引言 经皮肾镜取石术（PCNL）在过去几年中不断发展，其中一个发展成果是瓦尔迪维亚于1987年引入了仰卧位PCNL。这种方法为心血管和肺功能受损的患者提供了安全入路的额外优势。全身麻醉是PCNL首选的麻醉技术。然而，在过去十年中，该手术区域麻醉的使用有所增加。我们分享我们在区域麻醉下进行仰卧位PCNL治疗孤立性肾盂结石的经验。目的 评估在脊麻下进行仰卧位PCNL治疗直径1.5至3厘米的孤立性肾盂结石的可行性、安全性和有效性。材料与方法 这是一项对2022年1月至2022年12月在我院接受区域麻醉下仰卧位PCNL的35例患者（21例男性）的回顾性记录研究。所有患者均有一枚直径1.5 - 3厘米的孤立性肾盂结石。分析术中及术后数据。结果 患者的平均年龄为38.5±15岁。31例（89%）患者术后疼痛视觉模拟量表（VAS）评分<5分，4例（11%）患者评分>5分。平均住院时间为3.33±0.88天。血红蛋白水平平均下降0.49±0.43mg/dL。术后，3例患者（8.5%）出现轻度血尿，2例患者（5.7%）出现发热。本系列中未发生邻近器官损伤。仅1例患者需要输血。所有患者均实现结石完全清除。结论 在经验丰富的医生手中，区域麻醉下的仰卧位PCNL是一种可行、安全且有效的方法，并发症发生率极低。
