Anästhesie und klinische Forschung
Offener Zugang

Abstrakt

Percutaneous Nephrolithotomy under Thoracic Paravertebral Block: A Preliminary Report

Doaa G Ahmed, Diab Fuad Hetta and Abdelraouf M S Abdelraouf

Background: The second look percutaneous nephrolithotomy (PCNL) is usually done under general anesthesia. Thoracic paravertebral block has been shown to provide sufficient postoperative analgesia for a variety of thoracic and upper abdominal surgeries.

Objectives: We propose a case series study for performing the second look PCNL under paravertebral block (PVB) and conscious sedation using dexmedetomidine.

Methods: 33 patients scheduled for second look PCNL received PVB at the level of T 11, 15 ml of 0.5 % of bupivacaine was injected under ultrasonographic guidance. During the procedure, the patients received conscious sedation with dexmedetomidine (initial infusion of 1 μg/kg/h, followed by a maintenance infusion of 0.2 μg/kg/h). We measured the rate of success of the anesthetic technique, the level of sedation and hemodynamics. The time to complete recovery using (MPADSS), postoperative paracetamol consumption and postoperative intensity of pain using VAS.

Results: the anesthetic technique was satisfactory in 30 patients. The median (IQ) patient’s satisfaction with the anesthetic technique was 6 (6:7). The median (IQ) surgeon’s satisfaction with the anesthetic technique was 7 (6:7). Complete recovery from sedation using the modified post anesthesia discharge scoring system (time to score 10) was achieved within 40 (30:52.5) min. The mean MAP and heart rate were significantly decreased in comparison to baseline value.

Conclusion: We concluded that the anesthetic technique with PVB and conscious sedation with dexmedetomidine for patients undergoing second look PCN provided sufficient sedation, adequate analgesia, minimal side effects, and rapid recovery.