Patient and Staff Satisfaction in PCNL: Combined Spinal–Epidural vs General Anesthesia

Overview

This prospective study compared combined spinal–epidural anesthesia (CSEA) and general anesthesia in percutaneous nephrolithotomy (PCNL) focusing on satisfaction of surgeons, anesthesiologists, and operating room personnel. The study also evaluated postoperative pain, analgesic requirements, and surgical outcomes, finding distinct advantages in satisfaction and recovery profiles between the two anesthesia methods.

Background

Percutaneous nephrolithotomy is the recommended primary treatment for kidney stones larger than 20 mm, allowing effective stone removal with minimal renal damage. Surgery can be performed under general anesthesia or combined spinal–epidural anesthesia (CSEA), each with specific benefits. General anesthesia offers better hemodynamic and airway control, while CSEA is less invasive and may improve patient safety and recovery. Prior to this study, no research had evaluated the satisfaction of surgical and anesthesia teams with these anesthesia techniques during PCNL.

Data Highlights

Key Findings

• Surgeons, anesthesiologists, and operating room personnel reported satisfaction scores on a 0–10 scale, with scores categorized as very poor (0–2), poor (3–5), moderate (6–8), and good (9–10).
• CSEA was associated with reduced postoperative pain scores at 6 hours compared to general anesthesia.
• Patients receiving CSEA required fewer intravenous analgesics postoperatively and demonstrated earlier mobilization times.
• No significant differences were observed in surgical success rates or complication rates between the two anesthesia groups.
• General anesthesia provided advantages in airway and hemodynamic control, particularly in patients requiring upper pole puncture.
• CSEA was favored for its minimally invasive nature and potential to improve patient safety and early recovery.

Clinical Implications

Clinicians should consider CSEA as a viable anesthesia option for PCNL, especially when aiming to enhance patient comfort and reduce postoperative analgesic needs. While general anesthesia remains advantageous for airway management and hemodynamic stability, particularly in complex cases, CSEA may facilitate earlier mobilization and improve overall satisfaction among surgical and anesthesia teams. Individual patient factors and surgical complexity should guide anesthesia choice.

Conclusion

This study demonstrates that both combined spinal–epidural anesthesia and general anesthesia are effective for PCNL, with CSEA offering benefits in postoperative pain control and team satisfaction. These findings support tailored anesthesia approaches to optimize patient and staff outcomes in percutaneous nephrolithotomy.

References

1. European Urological Association Guidelines -- PCNL as primary treatment for large stones
2. Literature on anesthesia advantages in PCNL -- General vs Regional Anesthesia
3. Study on minimally invasive surgery and regional anesthesia benefits