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