Efficacy of Thoracic Segmental Spinal Anaesthesia in Percutaneous Nephrolithotomy: A Retrospective Observational Study

Abstract

Introduction: Percutaneous Nephrolithotomy (PCNL) is a minimally invasive procedure for the treatment of renal stone disease, usually performed under General Anaesthesia (GA). Regional anaesthesia, specifically Thoracic Segmental Spinal Anaesthesia (TSSA), offers a suitable alternative to mitigate complications associated with GA. TSSA in PCNL has an advantage over conventional lumbar spinal anaesthesia in terms of better haemodynamic stability, attributed to the lesser amount of local anaesthetic drug required. However, its clinical utility is yet to be fully explored. Aim: To investigate the feasibility and efficacy of TSSA in patients undergoing PCNL by analysing their medical records. Materials and Methods: A retrospective observational study was conducted on 250 patients from January 2022 to July 2023 at GNRC Medical, Guwahati, India. Patients aged 20- 70 years with American Society of Anaesthesiology (ASA) I and II classification, undergoing PCNL with renal stones ≤40 mm, were included. TSSA was administered at the T9-T10 intervertebral space. Intraoperative parameters, degree of motor and sensory block, post-operative analgesia, patient and surgeon satisfaction were recorded. Descriptive statistics of the study were analysed in Microsoft excel and presented as mean with standard deviation or as numbers and percentages. Results: The patients in the study had a mean age of 41.08 years, Body Mass Index (BMI) of 25.52 kg/m2 , stone size of 25.73 mm, and surgical duration of 74.92 minutes. TSSA was associated with minimal intraoperative hypotension (6%) and bradycardia (8.9%), zero incidences of neurological complications, and did not require conversion to GA. Complete stone clearance was achieved in 89.6% of cases. Post-operative analgesia was excellent in 179 (71.6%) patients as they did not require any rescue analgesia within the first 24 hours. Patient and surgeon satisfaction were notably high. Conclusion: TSSA emerges as a safe and efficient alternative to GA in selected cases of PCNL. Patient and surgeon satisfaction, along with minimal post-operative complications, support its consideration and usage. However, the choice of anaesthesia should be individualised based on procedural complexities and patient characteristics.