Percutaneous nephrolithotripsy under assisted localanaesthesia for high risk patients: Is it effective?

Abstract

Objectives: The aim of the present study is to evaluate the feasibility and safety of performing PNL underlocal anesthesia in a selected group of patients who are at high risk for general anesthesia.

Patients and methods: Forty seven patients underwent PNL under local anesthesia. There were 38 malesand 9 females with a mean age of 62 years. All patients were at medical high-risk for general anesthesia, withan American Society of Anesthesiologists (ASA) score of 3. The indications for local anesthesia in this studywere obstructed single functioning kidney with azotemia in 29 patients, hepatic insufficiency in 8 patients,cardiac problems in 7 patients and 3 patients had hepatocellular carcinoma. The mean stone size was 2.7 cm(range 2–3.1 cm). Local infiltration with 10–20 cc of 2% lidocaine at the site of puncture was used in allcases. Narcotics were given 30 min prior to the procedure and medazolam was given intraoperatively upondemand. Utrasound guided puncture was performed in all cases and tract dilatation was then done underfluoroscopy using high pressure balloon catheter in 35 and Alken’s metal dilators in 12 cases. Stones werethen retrieved after disintegration in the same cession in 33 patients, while the other 14 patients underwentstaged PNL, where a 12 Fr. nephrostomy tube was placed in the first stage, followed by tract dilatation andstone retrieval one week later.

Results: Out of 47 patients included, 44 had successful PNL either one stage (30 patients) or two stages(14 patients). Only 3 patients could not tolerate pain and the procedure was terminated after placement ofnephrostomy tube and stone retrieval was completed later under general anesthesia.\

Keywords: Percutaneous; Lithotripsy; Stones; Local anesthesia; High risk