Spinal vs. general anesthesia for percutaneous nephrolithotomy: A prospective randomized trial

Objective: To compare the efficacy and safety of general anesthesia (GA) vs. spinal anesthesia (SA) in percutaneous nephrolithotomy (PCNL). Methods: Two hundred patients were enrolled in a prospective randomized study to receive either GA or SA for PCNL. Patients' characteristics, vital parameters, visual analog scale (VAS) and needs for additional analgesia were evaluated. Intraoperative and post-operative complications were recorded. Patients' and surgeons' satisfactions were also compared. Results: Vital parameters were maintained at safe values throughout procedures in both groups. Visual analog pain score was lower in SA group till 1 h postoperative in comparison with GA group (P < 0.05). Patients in SA group recorded lower consumption of analgesia in the 1st postoperative day in comparison with GA group (P < 0.05). Postoperative shivering was higher in SA group than GA group (8% vs. 2%) while nausea and vomiting was higher in GA group than SA group (5% vs. 2% and 4% vs. 1% respectively). Patients in GA group reported higher overall satisfaction scores than SA group (mean 9.6 +/- 0.4 vs. 8.6 +/- 0.8, P < 0.05). Similarly, surgeon' satisfaction score was higher in favor of GA group compared with SA group (mean 10 +/- 00 vs. 8.3 +/- 0.4, P < 0.05). Conclusions: Both GA and SA are effective and safe in PCNL. SA has fewer complications and lower consumption of analgesia postoperatively. However, GA provides more satisfaction for patients and surgeon. (C) 2014 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Anesthesiologists.