Journal of endourology
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Journal of endourology · Oct 2009
Randomized Controlled Trial Comparative StudySpinal-epidural anesthesia versus general anesthesia in the management of percutaneous nephrolithotripsy.
To compare the efficacy between combined spinal-epidural block and general anesthesia in patients undergoing percutaneous nephrolithotripsy (PNL). ⋯ In patients undergoing PNL, spinal-epidural anesthesia and analgesia gave greater patient satisfaction, shorter times for PACU and home readiness, and less postoperative pain. Spinal-epidural anesthesia is an attractive alternative to general anesthesia in these patients.
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Journal of endourology · Oct 2009
Percutaneous endourologic procedures in high-risk patients in the lateral decubitus position under regional anesthesia.
The prone position is the most commonly used position for percutaneous endourologic procedures. It is usually combined with a general anesthesia. In high-risk patients, this approach can lead to circulatory and respiratory compromises. Operating on such patients in a full lateral position will minimize the hemodynamic and respiratory risks and-if combined with spinal anesthesia-will allow for increased patient comfort and safety. ⋯ The full lateral position-while necessitating expertise and some learning for renal puncture from an unusual angle-is safe in medical high-risk patients. It can be safely performed using regional anesthesia, avoiding the risks of general anesthesia and allowing for patient-anesthetist communication throughout the procedure. Cardiac and respiratory parameters are improved, stable, and easily controlled. As opposed to the supine position, the awake patient is more comfortable, and morbid obesity is not a problem.
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To evaluate the possibility of performing percutaneous nephrolithotomy (PCNL) under a multimodal analgesia regime. ⋯ The use of our multimodal analgesia regime is a well-tolerated and safe alternative to general or regional anesthesia for patients undergoing PCNL.
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Journal of endourology · May 2009
Randomized Controlled TrialEfficacy of peritubal local anesthetic infiltration in alleviating postoperative pain in percutaneous nephrolithotomy.
Percutaneous nephrolithotomy (PCNL) is a safe and effective endourologic procedure in patients with renal calculi. It is less morbid than open surgery. However, the patient complains of pain around the nephrostomy tube and demands for good postoperative analgesia. Skin infiltration with bupivacaine around the nephrostomy tube is not effective, so we hypothesize that peritubal infiltration of bupivacaine from renal capsule to the skin along the nephrostomy tract may alleviate postoperative pain. ⋯ In this study a significant difference in the pain scores and analgesic requirement was noted in the two groups of patients. Peritubal infiltration of 0.25% bupivacaine solution is efficient in alleviating postoperative pain after PCNL.
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Journal of endourology · Apr 2009
Continuous infusion of local anesthetic decreases narcotic use and length of hospitalization after laparoscopic renal surgery.
We sought to determine the efficacy of an extraction-incision infusion of local anesthetics through a continuous-infusion elastomeric pump (ON-Q) for the management of postoperative analgesia after laparoscopic nephrectomy and laparoscopic nephroureterectomy with intact specimen extraction. ⋯ A continuous infusion of 0.25% bupivacaine at 4 mL/hour through the ON-Q elastomeric infusion pump is a safe and effective adjunct in postoperative pain management after laparoscopy. Initial experience with the ON-Q Pain Relief System results in decreased narcotic use and decreased length of hospitalization compared with traditional postoperative pain management.