Clinical Scorecard: Evaluation of Patient and Surgical Staff Satisfaction with Combined Spinal–Epidural versus General Anesthesia in Percutaneous Nephrolithotomy: A Prospective Study

At a Glance

Key Highlights

• PCNL is the primary treatment for large kidney stones (>20 mm) allowing minimal kidney damage and effective stone removal.
• General anesthesia offers advantages in hemodynamic and airway control and higher satisfaction in upper pole puncture cases.
• CSEA reduces complication risks, supports minimally invasive surgery, and may improve early recovery and discharge.

Guideline-Based Recommendations

Diagnosis

• Use PCNL as primary treatment for stones larger than 20 mm according to European Urological Association guidelines.

Management

• Select anesthesia type (general anesthesia or CSEA) based on patient medical history, surgical requirements, and team expertise.
• General anesthesia involves intravenous induction and maintenance with desflurane and controlled ventilation.
• CSEA involves lumbar spinal injection of bupivacaine with epidural catheter placement for analgesia.

Monitoring & Follow-up

• Monitor heart rate, blood pressure, oxygen saturation continuously during surgery.
• Evaluate postoperative pain using visual analog scale (VAS) at 6 hours post-CSEA.
• Assess satisfaction scores of surgeons, anesthesiologists, and operating room personnel immediately after surgery.

Risks

• Exclude patients with uncontrolled diabetes, hypertension, cardiac arrhythmia, severe pulmonary disease, liver failure, coagulation disorders, cerebrovascular disease, or refusal of CSEA.
• Consider potential hemodynamic instability and airway management challenges with general anesthesia.
• Consider reduced complication risk and improved safety profile with CSEA.

Patient & Prescribing Data

44 patients undergoing PCNL, divided into general anesthesia and CSEA groups

CSEA may reduce postoperative analgesic requirements and support early mobilization; general anesthesia preferred for better airway and hemodynamic control especially in upper pole puncture cases.

Clinical Best Practices

• Preoperative assessment should exclude patients with significant comorbidities contraindicating CSEA.
• Use standardized satisfaction scoring (0–10 scale) for surgical team and anesthesia personnel to evaluate anesthesia effectiveness.
• Ensure adequate preoperative hydration and sedation prior to CSEA.
• Tailor anesthesia choice to patient condition, surgical complexity, and team expertise to optimize outcomes.
• Monitor postoperative pain with VAS and adjust analgesia accordingly.

References

• European Urological Association Guidelines on PCNL
• Study on anesthesia satisfaction in PCNL