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A comparative study of combined spinal epidural anaesthesia and general anaesthesia in patients undergoing percutaneous nephrolithotomy

Nilam D. Virkar, Geeta A. Patkar, R. Rohit, Bharati A. Tendolkar.

Background: Our primary aim was to study the efficacy, safety, hemodynamic stability, postoperative pain relief, and complication with combined spinal epidural anaesthesia (CSE) and to compare it with general anaesthesia (GA) for percutaneous nephrolithotomy (PCNL).
Methods: The present study was a prospective, randomized, open, controlled trial to compare the effects of CSE and GA in patients undergoing PCNL. Study was carried out in 100 adult patients, who were randomly divided into two groups of 50 each, Group GA and Group CSE. Post-operative pain relief and amount rescue analgesia required were noted. Postoperatively samples were collected for haemoglobin and arterial blood gases. Incidence of complications were noted and compared among both the groups.
Results: Mean arterial pressure in CSE group was less compared to GA group during the procedure. 30 % patients in group GA required first rescue analgesia within first hour of completion of surgery whereas no patient in group CSE required analgesia within first hour indicating better pain relief in CSE group. Mean haemoglobin and the fall in haemoglobin between the groups were comparable. 48.0% of the cases among GA group and 14.0% of the cases among CSE group had postoperative nausea and vomiting. Mean pH in GA group was 7.330.05 and in CSE group was 7.360.04. There was one case of hydrothorax post operatively.
Conclusions: We conclude that CSE is a safe alternative to GA for PCNL with better pain relief, less PONV. Hypotension due to sympathetic blockade is always a possibility.

Key words: Percutaneous nephrolithotomy, Spinal epidural anaesthesia, Hypotension, Postoperative nausea and vomiting, Post-operative pain

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