Perkütan Nefrolitotomi Yapılan Hastalarda Farklı Anestezi Yöntemlerinin Karşılaştırılması

Abstract

Amaç: Günümüzde, Perkütan nefrolitotomi (PNL) büyük ve kompleks böbrek taşları için ilk tercih edilen minimal invazif bir tedavi şeklidir. PNL operasyonu spinal ve genel anestezi altında yapılabilmektedir. Biz bu retrospektif çalışmada spinal ve genel anestezi altında yapılan  PNL ameliyatlarının etkinlik ve güvenirliliğini karşılaştırdık.

Gereç ve Yöntem: Çalışmaya kliniğimizde Ekim  2016 ve Ağustos 2018 tarihleri arasında PNL operasyonu yapılan toplam 82 hasta dahil edildi. Genel anestezi grubunda (grup 1) 34 ve spinal anestezi grubunda (grup 2) 48 hasta mevcuttu. Bütün hastaların taş ve üriner sistem özellikleri, operasyon parametreleri ve postoperatif bulguları kaydedildi. Karşılaştırmalarda Independent Samples t Test, Mann WhitneyU ve Ki-Kare testleri kullanıldı. P<0,05 anlamlı kabul edildi.

Bulgular: Sırasıyla; ortalama yaş, cinsiyet ve taş boyutu açısından iki grup arasında istatistiki olarak anlamlı farklılık saptanmadı(p=0.20, p=0.83, p=0.24). Ortalama operasyon süresi grup 1’de anlamlı olarak daha düşüktü (57,91±10,18 dk vs. 53,56±9,33 dk; p:0,04). Grup 1’de ortalama floroskopi süresi 4,43±1,54 dk iken grup 2’de 3,56±1,25 dk idi ve anlamlı farklılık izlendi (p=0,008). Grup 1’de taşsızlık oranı % 84,2 iken grup2’de bu oran % 85,5 olarak kaydedildi ve anlamlı farklılık saptanmadı (p =0,31). Ortalama hastanede kalış süreleri grup 1’de 51,08±11,27 saat, grup 2’de 50,12±11,18 saat idi (p=0,70). Grup 1’de postoperatif başağrısı olmazken, grup 2’de 4 hastada postoperatifbaş ağrısı oldu ancak bu fark istatistiksel olarak anlamlı değildi (p=0,13).

Sonuç: PNL operasyonu planlanan hastalarda spinal anestezi hızlı ve güvenilir bir anestezi yöntemidir. Spinal anestezinin operasyon ve skopi sürelerinin kısa olması gibi avantajları olması nedeni ile artan sıklıkta kullanılacağı düşünülmektedir.

Keywords

• Perkutan nefrolitotomi,Spinal anestezi,Genel anestezi

Comparison Of Different Anesthesia Methods In Patients With Percutaneous Nephrolithotomy

Abstract

Aim: Nowadays, percutaneous nephrolithotripsy (PNL) is the first choice of minimally invasive treatment for large and complex kidney stones. In this retrospective study, we compared the efficacy and safety of PNL surgeries performed under spinal and general anesthesia.

Method: A total of 82 patients who underwent PNL between October 2016 and August 2018 were included in the study. There were 34 patients in the general anesthesia group (group 1) and 48 patients in the spinal anesthesia group (group 2). All patients' stone and urinary system features, operation parameters and postoperative findings were recorded. Independent Samples t Test, Mann Whitney U and Chi-Square tests were used. P <0.05 was considered as statistical significance.

Results: There was no statistically significant difference between the two groups in terms of mean age, gender and stone sizes respectively (p = 0.20, p = 0.83, p = 0.24). The mean operative time was 57.91 ± 10.18 minutes (min) in Group 1 and 53.56 ± 9.33 min in group 2, and there was a statistically significant difference (p = 0.04). The mean fluoroscopy time in Group 1 was 4.23 ± 1.54 min and 3.56 ± 1.25 min in group 2 and there was a significant difference (p = 0.008). While the stone-free rate was 84.2% in group 1, this rate was 85.5% in group 2 and no significant difference was found (p = 0.31). The mean length of hospital stay was 51,08 ± 11,27 hours in group 1 and 50,12 ± 11,18 hours in group 2 (p = 0,70). There was no postoperative headache in group 1, but 4 patients had postoperative headache in group 2, but this was not statistically significant (p = 0.13).

Conclusion: Spinal anesthesia is a fast and reliable method of anesthesia in patients scheduled for PCNL. It is thought that spinal anesthesia will be used with increasing frequency as it has advantages of short operation and fluoroscopy times.

Keywords

• Percutaneous nephrolithotomy,Spinal anesthesia,General anesthesia

References

1. 1. Fernström I, Johannson B (1976) Percutaneouspyelithotomy: A new extraction technique. Scand J UrolNephrol 10(3): 257-259.
2. 2. Stening SG, Bourne S. Supracostal percutaneous nephrolithoto¬my for upper pole caliceal calculi. J Endourol. 1998;12(4):359–62.
3. 3. Jun-Ou J, Lojanapiwat B. Supracostalaccess: does it affect tube¬less percutaneous nephrolithotomy efficacy and safety? IntBraz J Urol. 2010;36(2):171–6.
4. 4. Karacalar S, Bilen CY, Sarihasan B, Sarikaya S. Spinal-epidural anesthesia versus general anesthesia in the management of percutaneous nephrolithotripsy. J Endourol. 2009;23:1591-7.
5. 5. Kuzgunbay B, Turunc T, Akın S, Ergenoğlu P, Arıboğan A, Ozkardeş H.Percutaneous nephrolithotomy under general versus combined spinal-epidural anesthesia. J Endourol 2009; 23: 1835-8.
6. 6. Warner MA, Shields SE, Chute CG. Major morbidityand mortality within1 month of ambulatory surgery and anesthesia. JAMA 1993; 270:1437-41.
7. 7. Borendal Wodlin N, Nilsson L, Carlsson P, Kjolhede P. Cost effectiveness of general anesthesia vs spinal anesthesia in fast-track abdominal benign hysterectomy. Am J ObstetGynecol 2011; 205:326.e1–7.
8. 8. Morgan GE, Maged SM. Clinical Anesthesiology. Second Edition. LosAngeles: Appleton-Lange, 1996.

9. 9. Ünsal A, Bozkurt ÖF, Kara C, Bayındır M, Oğuz U,Değerli S. Epidural anestezi ile perkütan nefrolitotomi. Türk Üroloji Dergisi 2008;34:311-4.
10. 10. Mehrabi S, Karimzadeh Shirazi K. Results and complications of spinal anesthesia in percutaneous nephrolithotomy. Urol J. 2010;7(1):22–5.
11. 11. Tekgül S, Dogan HS, Hoebeke P, et al. EAU Guidelines on Paediatric Urology. European Society for Paediatric Urology. European Association of Urology; 2016.
12. 12. Ramakumar S, Segura JW. Renal calculi. Percutaneous management. UrolClin NorthAm 2000;27:617-22.
13. 13. Nouralizadeh A, Ziaee SA, Hosseini Sharifi SH, et al. Comparison of percutaneous nephrolithotomy under spinal versus general anesthesia: a randomized clinical trial. J Endourol. 2013;27:974-8.
14. 14. Singh V, Sinha RJ, Sankhwar SN, Malik A. A prospective randomized study comparing percutaneous nephrolithotomy under combined spinal-epidural anesthesia with percutaneous nephrolithotomy under general anesthesia. Urol Int. 2011;87:293-8.
15. 15. Barak M, Putilov V, Meretyk S, Halachmi S. ET View tracheoscopic ventilation tube for surveillance after tube position in patients undergoing percutaneous nephrolithotomy. Br J Anaesth. 2010;104:501-4.
16. 16. Cicek T, Gonulalan U, Dogan R, Kosan M, Istanbulluoglu O, et al. (2014) Spinal anesthesia is an efficient and safe anesthetic method for percutaneous nephrolithotomy. Urology 83(1): 50-55.
17. 17. Gonen M, Sarı R, Cicek T, Dursun M, Ozturk B. Spinal ve genel anestezi altında uygulanan tupsuz perkutan nefrolitotomi. TurkUroloji Dergisi2010; 36: 33-7.
18. 18. Pu C, Wang J, Tang Y, Yuan H, Li J, et al. (2015) The efficacy and safety of percutaneous nephrolithotomy under general versus regional anesthesia: a systematic review and meta-analysis. Urolithiasis 43(5): 455-66.
19. 19. Liu X, Huang G, Zhong R, Hu S, Deng R. Comparison of Percutaneous Nephrolithotomy Under Regional versus General Anesthesia: A Meta-Analysis of Randomized Controlled Trials. Urol Int 2018;101(2):132-42.
20. 20. Mehrabi S, MousaviZadeh A, AkbartabarToori M, Mehrabi F. Gen¬eral versus spinal anesthesia in percutaneous nephrolithotomy. Urol J. 2013;10(1):756–61.