Comparison of Hemodynamic Stability and Pain Control in Lateral and Prone Positions in Patients Undergoing Percutaneous Nephrolithotomy: A Randomized Controlled Trial
Urology Journal,
Vol. 17 No. 2 (2020),
16 Esfand 2020
,
Page 124-128
https://doi.org/10.22037/uj.v17i2.4915
Abstract
Purpose: Percutaneous nephrolithotomy (PCNL) is the preferred surgical treatment in many cases of kidney stones which is performed in different positions such as prone, lateral, and supine. This study was designed to evaluate whether patient position (lateral versus . prone) has an effect on the need for analgesia and onset of pain after surgery.Materials and Methods: Patient with confirmed kidney stones (size ? 2 cm) who were candidates for PCNL were enrolled in this study. The required biochemical analyses were performed preoperatively. All patients underwent spinal anesthesia by the same anesthesiologists and then were randomly divided into two separate groups as lateral (L) and prone (P) positions. The operations’ start and end time, required time for proper access into target calyces, additional need for analgesic or cardiac drugs, duration of analgesia, and onset of pain after PCNL were carefully recorded and then compared between the two groups.
Results: In total, 51 patients were evaluated of whom 39 were men and 12 were women. Mean duration of analgesia after PCNL surgery in P group (173 ± 8 min) was significantly longer than in L group (147±12 min) (P = .001). Furthermore, the amount of ephedrine usage in L group (3.6 ± 1.5mg) was significantly lower than in the P group (16.4 ± 12mg), suggesting more hemodynamic variations in the P group during the operation.
Conclusion: Our randomized control trial study shows that choosing the optimal position in the PCNL technique depends on patient's condition. If hemodynamic control is of matter to the anesthesiologist, then lateral position is more appropriate. However, if control of pain and longer time of analgesia are important, prone position may be preferred.
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References
- Rozentsveig V, Neulander AZ, Russabrov E, Schwart A,Lismar l, Gurevich B,et all. Anesthetic considrations during percutaneous nephrolithotomy. Journal of clinical anesthesia 2007;19(5):351-5
- Mehrabi S, Karimzadeh K, Result and complication of spinal anesthesia in PCNL. Uro J 2010 7;7(1):22-5
- Aravantinos E, Karatzas A, Gravas S, Tzortzis V, Melekos M. Feasibility of percutaneous nephrolithotomy under assisted local anaesthesia: a prospective study on selected patients with upper urinary tract obstruction. Eur Urol.
;51:224-7; discussion 8.
- PU C, et al. The efficacy and safety of percutaneous nephrolithotomy under general versus regional anesthesia: a systematic review and meta-analysis. Urolithiasis 2015
- Nouralizadeh A, et al. Percutaneous nephrolithotomy under spinal versus general anesthesia: a randomized clinical trial. J Endourol. 2013
- El-Husseiny T, et al. Percutaneous endourologic procedures in high-risk patients in the lateral decubitus position under regional anesthesia. J endourol 2009
- Gofrit ON, Shapiro A, Donchin Y et al (2002) Lateral decubitus position for percutaneous nephrolithotripsy in the morbidly obese or kyphotic patient. J Endourol 16:383–386
- Yanbo Wang, Yan Wang, Yunming Yao, Ning Xu, Haifeng Zhang, Qihui Chen, Zhihua Lu, Jinghai Hu, Xiaoqing Wang, Ji Lu, Yuanyuan Hao, Fengming Jiang,, Yuchuan Hou, and Chunxi Wang.. Prone versus Modified Supine Position in Percutaneous Nephrolithotomy: A Prospective Randomized Study. Int J Med Sci. 2013; 10(11): 1518–1523.
- Theocharis Karaolides, Konstantinos Moraitis, Christian Bach, Junaid Masood, Noor Buchholz. Positions for percutaneous nephrolithotomy: Thirty-five years of evolution. Arab Journal of Urology Volume 10, Issue 3, September 2012, Pages 307–316
- Karami H, Rezaei A, Mohammadhosseini M et al (2010) percutaneous nephrolithotomy in the flank position versus fluoroscopy-guided percutaneous nephrolithot omy inthe prone position: comparative study. J Endourol
- Hosein Khoshrang, Siavash Falahatkar, Sara Ilat, Manzar Hossein Akbar, Maryam Shakiba, Alireza Farzan, Nadia Rastjou, Herfeh & Aliakbar Allahkhah Comparative Study of Hemodynamics Electrolyte and Metabolic Changes During Prone & Complete Supine Percutaneous Nephrolithotomy. Nephrourol Mon. 2012 autumn; 4(4): 622–628
- Dharmavaram S, Jellish WS, Nockels RP, Shea J, Mehmood R, Ghanayem A, Kleinman B, Jacobs W. Effect of prone positioning systems on hemodynamic and cardiac function during lumbar spine surgery: an echocardiographic study. Spine (Phila Pa 1976). 2006 May 20; 31(12): 1388-93; discussion 1394.
- Abbas Basiri, Seyed Amir Mohsen Ziaee. Totally Ultrasonography-Guided Percutaneous Nephrolithotomy in the Flank Position. Journal of endourology / Endourological Society 22(7):1453-7 • August 2008
- Dasgupa, Ranana, Patel, Anup b. pcnl: dose position matter?prone ,supine, and variation. Current opinion in urology march 2013
- Cracco, cecilia maria, Alken, peter b, scoffone, cesare marco Positioning for pcnl current opinion in urology jan 2016
- Fatemeh Roodneshin, MD Mohammadreza Kamranmanesh, MD Alireza Jafari, MD Nima Hassanzad, MD pioid-Sparing effect of spinal vs. general anesthesia on post-operative analgesia in percutaneous nephrolithotrypsy: a randomized clinical trial
- Effect of patient position and hypotensive anesthesia on inferior vena caval pressure. Lee TC1, Yang LC, Chen HJ. Spine (Phila Pa 1976). 1998 Apr 15;23(8):941-7; discussion 947-8.
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