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, 47 (9), 4143-4150

Comparison of the Clinical Efficacy of Sonography-Guided Percutaneous Nephrolithotomy (PCNL) Under Local and General Anesthesia

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Comparison of the Clinical Efficacy of Sonography-Guided Percutaneous Nephrolithotomy (PCNL) Under Local and General Anesthesia

Xunbao Wang et al. J Int Med Res.

Abstract

Objective: This study aimed to compare the effect of percutaneous nephrolithotomy (PCNL) under local infiltration anesthesia (PCNL-LIA) and general anesthesia (PCNL-GA) to treat upper urinary tract calculi on clinical application values.

Methods: Patients were randomly divided into the PCNL-LIA (16 patients) and PCNL-GA (20 patients) groups. Data on safety, cost, complications, rate of residual calculi, and prognosis were compared.

Results: The mean operation time in the PCNL-LIA group was less than that in PCNL-GA group (100±7.7 versus 120±9.0 minutes). The mean length of hospital stay in the PCNL-LIA group was shorter than that in the PCNL-GA group (6.9±0.5 versus 10.5±1.2 days). The rate of patients who required blood transfusion because of blood loss during or after surgery was less in the PCNL-LIN group than in the PCNL-GA group (13% versus 40%). The intervention rate in the PCNL-GA group was higher than that in the PCNL-LIA group. Visual analogue pain scale assessment showed that the PCNL-LIA group showed slightly more pain than the PCNL-GA group.

Conclusion: PCNL-LIA is safer, faster, and more convenient, and it also provides the benefits of a lower rate of blood loss and complications, lower cost, faster recovery, and shorter hospital stay compared with PCNL-GA.

Keywords: Percutaneous nephrolithotomy; blood transfusion; local infiltration anesthesia; pain; residual calculi; upper urinary tract; visual analogue scale.

Figures

Figure 1.
Figure 1.
Representative images of the patients. (a, b, c, and e) Preoperative computed tomography and radiography of the kidneys, ureters, and bladder show multiple calculi in the left kidney, along with calculi at the lower part of the right ureter. (d) A patient answered questions and walked immediately after operation. The visual analogue pain scale level was 5. (f) Postoperative radiography of the kidneys, ureters, and bladder shows good fragmentation and removal of calculi. The operation time was 180 minutes. No auxiliary intravenous anesthesia method was used and the patient was discharged from our hospital at day 7.
Figure 2.
Figure 2.
Comparison of three clinical application values between the two anesthesia methods. (a) The operation time (minutes) was compared between the PCNL-LIA and PCNL-GA groups. (b) The hospital stay (days) was compared between the PCNL-LIA and PCNL-GA groups. (c) Costs were converted to US dollars and compared between the PCNL-LIA and PCNL-GA groups. PCNL-LIA: percutaneous nephrolithotomy under local infiltration anesthesia; PCNL-GA: percutaneous nephrolithotomy under general anesthesia.
Figure 3.
Figure 3.
Evaluation of efficacy of surgery between the two groups of patients. Percentile comparisons of the rate of blood transfusion, intervention, complex calculi, and residual stones between the PCNL-LIA and PCNL-GA groups are shown. These data are descriptive percentile rate comparisons. Therefore, statistical methods were not applicable, and no P values for comparison (significance) were provided. PCNL-LIA: percutaneous nephrolithotomy under local infiltration anesthesia; PCNL-GA: percutaneous nephrolithotomy under general anesthesia.

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