Post Operative Pain, Success Rate Under Segmental Epidural
Conditions
Keywords
Segmental Epidural, Regional Anesthesia for PCNL
Brief summary
Management of nephrolithiasis has been revolutionized by the advent of shock-wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL). PCNL is a minimally invasive endoscopic technique and is used for the fragmentation and removal of stones of size more than 20 to 30 mm, staghorn stones or multiple stones resistant to ESWL. Anaesthesia for PCNL is a challenge because of the disease, surgical procedure, positioning, hypothermia,and the possibility of fluid absorption, dilutional anaemia and blood loss. General anaesthesia is the gold standard for this surgery.The advent of new drugs has refined the technique of general anaesthesia. However there are several issues related to prone position still to be addressed like accidental extubation and difficult reintubation, nerve injuries and post operative respiratory complications. Combined spinal epidural(CSE) and only epidural anaesthesia (EA) is a well established technique of anaesthesia for upper abdomen and lower thoracic surgeries. It use has also been reported in PCNL surgeries.Segmental epidural can selectively blocks pain fibres from the surgical site. This not only allows to limit the dose of the local anaesthetics, but also limit motor and sympathetic blockade. Selective sympathetic block is associated with respiratory, cardiac, gastrointestinal and metabolic benefits. This formed the basis of our current study. In the present study the investigators aimed to evaluate the efficacy of segmental epidural for PCNL and compared it with standard technique i.e. GA.
Detailed description
To evaluate efficacy the investigators compared intraoperative haemodynamics, surgical clearance of stones, post operative pain, surgeon's and Patient's satisfaction scores and postoperative complications and side effects in 60 ASA I and II patients undergoing PCNL surgery who received either General anesthesia or Segmental epidural Anesthesia.
Interventions
PROCEDUREPCNL under General Anesthesia
Patients undergoing percutaneous Nephrolithotomy received General anesthesia.
PROCEDURESegmental Epidural Anesthesia
Patients undergoing PCNL surgery received Segmental epidural anesthesia with 0.5% bupivacaine.
Sponsors
Maharashtra University of Health Sciences
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SCREENING
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* ASA I/II * Age - 18 years to 60 years * Either sex * BMI \< 30
Exclusion criteria
* Unwilling for consent * ASA 3 * Obesity with BMI \> 30. * Contraindications for Epidural Anaesthesia * Undilated pelvicalyceal system
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hemodynamic parameters: Change in heart rate per minute from baseline | Every 15 minutes for 2 hours and then every hourly till 24 hours | Change in heart rate per minute from baseline |
| Postoperative Pain using VAS | Postoperatively every hourly for 24 hours | Post operative pain was studied using VAS |
| Hemodynamic parameters; change in Mean arterial pressures in mm Hg from baseline | Hemodynamic parameters Change in Mean Arterial Pressure in mm Hg Every 15 minutes for 2 hours and then every hourly till 24 hours | change in mean arterial pressure from baseline |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Surgeon satisfaction score | 10 minutes Postoperative | (0-extremely poor, 1-poor, 2-fair, 3-good, 4-excellent). |
Outcome results
None listed