Objective: To evaluate the safety, efficacy, and feasibility of minipercutaneous nephrolithotomy (MPCNL)
under mixture of local anesthetics (MLA) vs spinal anesthesia (SA) for management of large renal stones.
Patients and Methods: This study was a prospective randomized controlled study and approved by IRB (RECFOMBU). A total of 120 consecutive patients who met the inclusion criteria of the study and agreed to sign the
informed consent form were randomized to undergo MPCNL under MLA (60 patients) or SA (60 patients).
Intra- and postoperative findings including visual pain analogue scale (VAS), operative time, hospital stay,
adverse events (AEs), stone-free rate, and related data were recorded.
Results: Baseline characteristics and demography included age and gender; stone’s site, size, and density were
comparable for both groups ( p > 0.05). The average VAS scores in the MLA group at 0, 2, 6, 12, and 24 hours
were 2.5, 0, 1, 1, and 0, respectively. The corresponding values in the SA group were 2, 1, 2, 2, and 1,
respectively, ( p < 0.05). The average operation time was *1 hour for both groups and the length of hospital
stay was 1.5 days for both groups ( p > 0.05). Whereas the mean hemoglobin deficit was 1.04% – 0.54% vs
1.27 – 0.46 ( p = 0.013) and the primary postoperative stone clearance was 93.4% vs 88.3% ( p > 0.05), for MLA
and SA groups, respectively. Postoperative analgesic consumption and complications were similar in the MLA
and SA groups.
Conclusion: Single tract MPCNL is feasible under either MLA or SA with comparable stone clearance and
AEs. Perioperative VAS was similar and acceptable for both modalities. |
