With immense improvement in endoscopic and laser technology in the recent years, minimally invasive surgery like Retrograde Intrarenal Surgery (RIRS) is becoming more popular in the treatment of renal calculi. To date the surgery has been largely performed under GA with very limited number of studies on regional anaesthesia for RIRS. The aim of the present study was to evaluate the feasibility and efficacy of Spinal anaesthesia for RIRS.
A prospective observational study was performed in patients, undergoing Retrograde Intrarenal Surgery, between the period from 1st September 2017 to 31st May 2018, in the Department of Anaesthesiology, Lakeshore Hospital. 50 patients satisfying the inclusion criteria were alternatively given General Anaesthesia (n=25) or Spinal Anaesthesia (n=25). GA and SA techniques were standardised for all the patients in the respective group. The surgery was performed by same experienced surgeon in both the groups. The following parameters were recorded and evaluated:
1) Hemodynamic variables- Heart Rate (HR), Blood Pressure (BP), Blood oxygen saturation (SpO2) , End tidal carbon dioxide (ETCO2) [up to 90 minutes].
2) Surgeon ‘s satisfaction.
3) Complications (Bleeding, Shivering).
4) Additional analgesic requirement.
5) Patient ‘s Satisfaction.
6) Post operative events- Post Operative Nausea Vomiting (PONV), Post Dural Puncture Headache (PDPH).
7) Level of block (at beginning and end of surgery).
Chi-square test and Fischer ‘s exact test was used for the comparison of qualitative variables. Independent sample t-test was used for the comparison of quantitative variables. A p value< 0.05 was considered significant.
Statistical analysis showed that hemodynamic variables in SA group were stable and comparable to GA group. There was no significant difference between the two groups with regards to surgeon ‘s satisfaction and patient ‘s satisfaction, and the surgeon and patients gave a satisfactory response in both the groups. The need for intraoperative analgesic requirement was higher in GA group with 72% requiring iv Paracetamol 1gm, 12% requiring iv Tramadol 100mg and 8% requiring an additional iv Fentanyl 50 mcg. With regards to complications, there was a significantly higher incidence of PONV in the GA group (p value 0.09). Shivering was slightly higher in the SA group; though not statistically significant. In all patients in the SA group, it was possible to attain a level of T8 at the beginning of surgery and effective block was maintained till the end of surgery without the need for supplemental analgesics or conversion to GA.
Thus we concluded that Spinal anaesthesia is as effective and feasible as general anaesthesia in RIRS and is associated with lesser analgesic requirement and PONV, with good surgeon and patient satisfaction.