Comparison of Epidural Anesthesia and Dexmedetomidine infusion with General Anesthesia for percutaneous Nephrolithotomy in prone position - An Observational Study

Abstract

BACKGROUND :We conducted this study to find out the efficacy of epidural anesthesia with dexmedetomidine sedation as an alternative to GA for PCNL.
OBJECTIVES: To compare efficacy and feasibility of performing PCNL under epidural anesthesia combined with dexmedetomidine infusion versus GA in terms of patient and surgeon satisfaction, postoperative pain relief and associated side effects.
STUDY DESIGN: An Observational Prospective study
PARTICIPANTS: 225 patients ASA I and II, of either sex, age > 18yrs were studied, 115 were allocated to Group A (Epidural) and 110 were allocated to Group B (General Anesthesia).
METHODS: Group A patients received Epidural Anesthesia with i.v dexmedetomidine infusion. Group B patients received General Anesthesia. The time to first rescue analgesia, postoperative visual analog scale (VAS) score, total analgesic requirement, patient satisfaction scores, surgeon satisfaction scores and adverse effects were compared between the two groups.
RESULTS: The mean heart rate in Group A was lower than Group B (p<.001). Both groups had a fall in MAP but hypotension was not seen. The time to first rescue analgesic was longer in Group A and total analgesic dose given was less due to lower mean VAS scores during the first 24 hrs (p<.05). Postoperative nausea, vomiting and shivering was observed more in Group B (p<.05). Pneumothorax was seen in 1 patient in Group A and was attributed to surgical cause. Mean patient satisfaction score in Group A was higher, likely due to better postoperative analgesia and less PONV. The mean surgeon satisfaction score was higher in Group A compared to Group B (p>.05) but the type of anesthesia did not significantly affect the surgeon’s performance.
CONCLUSION: Present study shows that EA and i.v dexmedetomidine can be safely used for PCNL and is an excellent alternative to GA, with more patient satisfaction, less postoperative pain, early recovery, less analgesic requirements and less adverse effects from systemic medication.
IMPLICATIONS: In high risk patients, EA is a safer alternative to GA, but requires a skilled anesthetist and an expert surgeon.