Abstract
General Anaesthesia with controlled ventilation is the most commonly used anaesthetic method for percutaneous nephrolithotomy. Although central neuraxial blockade provides good analgesia and stress suppression, spontaneous respiration with these techniques makes the procedure difficult for the surgeon. In this study Epidural analgesia is provided along with general anaesthesia to improve haemodynamic stability and decrease the peri-operative use of sedatives and analgesics thereby making recovery smooth. 100 patients undergoing PCNL were randomly allocated into two groups of 50 patients each. Group 1 (E) received Epidural Analgesia before induction of general anesthesia using 8ml of 0.2% Ropivacaine. Group 2 (C) patients received general anaesthesia alone like the group 1 patients. Haemodynamic responses [Systolic and diastolic BP, heart rate] were assessed in intraoperative period and in the immediate recovery. Recovery (pain & comfort) was assessed by ‘VAS” (Visual Analogue Scoring system). In the recovery if there were complaints like pain, increased blood pressure or tachycardia further supplementation of epidural drugs was given in Group 1(E). In group 2 (C) these problems were managed by systemic drugs like tramadol, fentanyl or antihypertensives as needed. The results showed that epidural analgesia with 0.2% Ropivacaine is effective in controlling the intraoperative and postoperative rise in blood pressure associated with PCNL, but was not very effective in the control of rise in heart rate during the intraoperative and postoperative period. The recovery profile of patients in Group 1(E) showed lesser post operative pain and fewer patients in Group 1(E) had complications like shivering and hypertension.
Keywords: Epidural analgesia, Ropivacaine, PCNL.
References
- Vorrakitpokatorn P, Permtongchuchai K, Raksamani E, Phettongkam A; Periope-rative complications and Risk Factors of Percutaneous Nephrolithotomy; J. Med. Assoc. Thai 2006; 89 (6): 826 – 33.
- Mohta M, Bhagchandani T, Tyagi A, Pendse M, Sethi AK. Haemodynamic, electrolyte and metabolic changes during percutaneous nephrolithotomy. Int Urol Nephrol 2008; 40 (2): 477-82.
- Mehrabi S , Sirazi K. Results and complications of spinal anesthesia in percutaneous nephrolithotomy. Urol J 2010; 7 (1): 22-5.
- Mehrabi S, Zadeh M, Tori A, Mehrabi F. General versus spinal anesthesia in percutaneous nephrolithotomy. Urol J 2013; 10 (1): 756 – 61.
- Etcheberry JR. Regional Anaesthesia & Stress response. Chapter 11; Regional Anesthesia & Pain management: Current perspective 2000: 85-6.
- Malhotra V, Sudheendra V, O’Hara J, Malhotra A. Anesthesia and the Renal and Genitourinary systems. Chapter 72, Miller’s Anaesthesia (8th ed).Elsevier Saunders: Philadelphia; 2015. p. 2218-9.
- Akerman B ,Hellbery IB , Trossik C , Primary evaluation of the local anesthestic properties of the amino amide agent Ropivacaine . Acta Anesthesiol Scand 1988;32:571- 8.
- Brockway MS, Bannister J, McClure JH, et al. Comparison of extradural ropivaca-ine and bupivacaine. Br J Anaesth 1991;66:31-7.
- Bader AM, Datta S, Flanagan H, Covino BG. Comparison of bupivacaine and ropivacaine induced conduction blockade in the isolated rabbit vagus nerve. Anesth Analg 1989;68:724-7.
- Morrison LMM, Emanuelsson BM, McClure JH, et al. Efficacy and kinetics of extradural ropivacaine: comparison with bupivacaine. Br J Anaesth 1994;72:164-9.
- Tangipaitoon T , Nisoog C , Loganpuvat B , Efficacy and safety of percutaneous nephrolithtomy ; A Prospective and randomized controlled study comparing regional epidural anesthesia with general anesthesia .Int. Braz J Urol . 2012 Aug ; 38 ( 4 ) : 504 – 511.
- Ugras M Y ,Toprak H I , Gunen H , Gucel A, Gunas A ; Infiltration of skin , nephrostomy tract and renal puncture site with Ropivacaine decreases pain and improve ventilator function after percutaneous nephrolithotomy J Endourology 2007 ; 21 :499 – 503.
- Parikh GP , Shah V R , Vora K S , Parikh BK , Modi MP , Panchal A ; Ultrsound guided peritubal infiltration of 0.2% Ropivacaine for post operative pain relief after percutaneous nephrolithotomy; Middle East Journal Anesthesiology 2013 ; 22 : 149- 54.
- Parikh GP , Shah VR ,Vora K S , Parikh BK , Modi PK ,Kumari P. Ultrasound guided peritubal infiltration of 0.25% Bupivacaine and 0.2% Ropivacaine for post operative pain relief after percutan-eous nephrolithotomy ; A prospective double blind randomized study . Indian Journal of Anesthesia 2014 ; 58 : 293-7.
- Twardowski P, Owczuk R, Wujtewicz MA, Wojciechowski J etal. The influence of epidural anaesthesia on the electrical activity of heart atria. Kardiochir Torakochirurgia Pol.2014 Jun;11(2): 156-61.
Corresponding Author
Susan T. Cheeran
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DOI: https://dx.doi.org/10.18535/jmscr/v5i12.81
