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.

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Susan T. Cheeran

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