'Single puncture' mini-percutaneous nephrolithotomy under assisted local anesthesia

Abstract

Objective: To evaluate the possibility of performing minipercutaneous nephrolithotomy (mini-PCNL) under assisted local anesthesia in a selected group of patients. Patients and Methods: Twenty-one patients with unilateral renal obstruction requiring mini-PCNL were enrolled in the study. Prior to surgery, all patients received: a) paracetamol 1.2 g intravenous (i.v.); b) parecoxib (COX2 inhibitor) 40 mg i.v., and c) infiltration of the surgical field with local anesthetic (20 ml of 1% lidocaine). Prior to the dilatation, all patients received midazolam 2 mg i.v. and fentanyl 100 mg i.v. Percutaneous renal tract access was created with ultrasound guidance. All patients were informed of the possibility of experiencing short periods of discomfort or pain, and all patients completed a postoperative visual analogue pain scale questionnaire. Results: All 21 patients completed the study, and the procedure was well-tolerated. Only three patients complained of mild pain and received additional fentanyl. Intraoperative problems and postoperative complications were mainly attributed to the mini-PCNL procedure itself rather than to the analgesic regimen administered. No complications related to the modality of anesthesia were encountered. The mean visual analogue pain scale score at the end of the procedure was 2.9 ± 0.9. Patients were directly transferred back to the ward immediately after the operation. Conclusions: Our study indicates that mini-PCNL can be performed safely and effectively under assisted local anesthesia in a selected group of patients. Copyright © 2010 S. Karger AG, Basel.