Minimally invasive percutaneous nephrolithotomy under peritubal local infiltration anesthesia

To evaluate the feasibility and safety of performing minimally invasive percutaneous nephrolithotomy (MPCNL) under peritubal local infiltration anesthesia. From December 2007 to December 2009, 88 patients with upper urinary calculi underwent MPCNL with ultrasonography (US)-guided renal access in the lateral decubitus flank position under peritubal local infiltration anesthesia. All patients were informed about the possibility of experiencing short periods of discomfort or pain and completed visual analog pain scale (VAS) questionnaires during the intra-operation and at 4, 24, and 48 h postoperatively. Postoperative narcotic usage was recorded at 24 and 48 h postoperatively. Eighty-two patients (93.2%, 82/88) underwent MPCNL under local anesthetic infiltration, 6 patients were converted to general anesthesia (2.2%, 2/88) or epidural anesthesia (4.4%, 4/88) because of serious pain or discomfort. The average VAS scores intra-operation and at 4, 24, and 48 h postoperatively were 3.1, 3.0, 2.4, and 2.1, respectively. Six patients (7.3%, 6/82) and 2 patients (2.4%, 2/82) were administered pethidine (75 mg) at 24 and 48 h postoperatively, respectively. The stone clearance rate was 88.3% (91/103) before discharge with MPCNL mono-therapy. The mean operative time was 89 min (range 56-145 min). MPCNL under peritubal local infiltration anesthesia is well-tolerated and feasible alternative to the same procedure under general or epidural anesthesia.