Safety and Efficacy of Spinal Anaesthesia for Ureteroscopy and in Situ Lithotripsy in Proximal Solitary Pelvic Stones
Spinal Anesthesia in Situ Lithotripsy in Proximal Solitary Pelvic Stones
DOI:
https://doi.org/10.54393/pjhs.v6i8.3164Keywords:
Spinal Anesthesia, Ureteroscopy, In Situ Lithotripsy, Pelvic Stones, Safety, Patient Satisfaction, Complications, Recovery TimeAbstract
Ureteroscopy and in situ lithotripsy provide an alternative treatment for patients with proximal solitary pelvic stones, but their safety and efficacy using spinal anesthesia are poorly studied. Objectives: To evaluate the safety, efficacy and patient satisfaction with spinal anesthesia during these procedures. Methods: A single-arm, prospective observational study was conducted at Islam Medical College, Sialkot, from May to October 2024, involving a total of 81 patients aged 20 to 60 years, ASA class I to III, who underwent elective ureteroscopy or lithotripsy. 15 mg of 0.75% bupivacaine was used to perform spinal anesthesia at the L3-L4 interspace. The main endpoints were success, complications, recovery times, and patient satisfaction. Other secondary outcomes were intraoperative hypotension, bradycardia, pain as measured by visual analogue scale (VAS) and post-dural puncture headache (PDPH). SPSS version 26.0 was used for statistical analysis. Results: A total of 97.5% patients completed the procedure under spinal anesthesia. The mean procedure time was 37.4 ± 6.2 min. In 53.1% of patients, the maximum sensory blockade level was T6. Hypotension (14.8%), bradycardia (6.2%), and PDPH (2.5%) were the complications. Next, postoperative pain significantly decreased over the 24 hours. In 55.6% of patients, excellent satisfaction was observed. Mean recovery time was 165.3 ± 22.4 minutes. Conclusions: Overall, spinal anesthesia for ureteroscopy and in situ lithotripsy in patients with proximal solitary pelvic stones is safe, effective, and has a high patient satisfaction rate.
References
Khoshrang H, Damavand RS, Nasseh H, Tavakoli AA, Esmaeili S, Ghaffari M et al. Comparing Spinal Anesthesia Approaches for Transurethral Lithotripsy in Patients with Proximal Ureteral Stones: A Randomized Clinical Trial of Bupivacaine Alone Versus Bupivacaine with Fentanyl. Journal of Medicine and Life. 2023 Oct; 16(10): 1508.
Oztekin U, Caniklioglu M, Atac F, Kantekin CU, Gurel A, Isikay L. Comparison of Safety and Efficiency of General, Spinal and Epidural Anesthesia Methods Used for the Endoscopic Surgical Treatment of Ureteral Stones: Which One Is Better to Access the Ureter and Reach the Stone? Urology Journal. 2020 May; 17(3): 237-42.
Sahan M, Sarilar O, Akbulut MF, Demir E, Savun M, Sen O et al. Flexible Ureterorenoscopy and Laser Lithotripsy with Regional Anesthesia Vs General Anesthesia: A Prospective Randomized Study. International Brazilian Journal of Urology. 2020 Sep; 46(6): 1010-8. doi: 10.1590/s1677-5538.ibju.2019.0770. DOI: https://doi.org/10.1590/s1677-5538.ibju.2019.0770
Joshi GP. General Anesthetic Techniques for Enhanced Recovery After Surgery: Current Controversies. Best Practice and Research Clinical Anesthesiology. 2021 Dec 1; 35(4): 531-41. doi: 10.1016/j.bpa.2020.08.009. DOI: https://doi.org/10.1016/j.bpa.2020.08.009
Alnsour TM, Altawili MA, Alghuraybi SM, Alshammari JE, Alanazi AG, Alanazi MG et al. Comparison of Ventilation Strategies Across the Perioperative Period in Patients Undergoing General Anesthesia: A Narrative Review. Cureus. 2025 Jan; 17(1). doi: 10.7759/cureus.77728. DOI: https://doi.org/10.7759/cureus.77728
Peng Y, Wang L, Jin J, Jiang Y, Xu Q, Yang L et al. Flexible Ureteroscopy Under Local Anesthesia for Stone Management: Initial Exploration and Two-Year Experience. Postgraduate Medicine. 2023 Oct; 135(7): 755-62. doi: 10.1080/00325481.2023.2265991. DOI: https://doi.org/10.1080/00325481.2023.2265991
Ho Y, Wen YC, Lee LM, Lin KH, Hsiao CH, Syu SH et al. Comparison of Regional and General Anesthesia for Retrograde Intrarenal Surgery: A Systematic Review and Meta-Analysis. Frontiers in Surgery. 2025 Apr; 12: 1422660. doi: 10.3389/fsurg.2025.1422660. DOI: https://doi.org/10.3389/fsurg.2025.1422660
Wang W, Gao X, Ma Y, Di X, Xiao K, Zhou L et al. Regional vs General Anesthesia for Retrograde Intrarenal Surgery: A Systematic Review and Meta-Analysis. Journal of Endourology. 2020 Nov; 34(11): 1121-8. doi: 10.1089/end.2020.0188. DOI: https://doi.org/10.1089/end.2020.0188
Ammer LS, Dohrmann T, Muschol NM, Lang A, Breyer SR, Ozga AK et al. Disease Manifestations in Mucopolysaccharidoses and Their Impact on Anaesthesia-Related Complications—A Retrospective Analysis of 99 Patients. Journal of Clinical Medicine. 2021 Aug; 10(16): 3518. doi: 10.3390/jcm10163518. DOI: https://doi.org/10.3390/jcm10163518
Koo CH and Ryu JH. Anesthetic Considerations for Urologic Surgeries. Korean Journal of Anesthesiology. 2020 Apr; 73(2): 92-102. doi: 10.4097/kja.19437. DOI: https://doi.org/10.4097/kja.19437
Ratanatherawichian Y, Preechakoon B, Pungkate P, Intarakaew T, Vichitvejpaisal P. Perioperative Nursing Considerations for Transurethral Resection Prostatectomy. Journal of the Medical Association of Thailand. 2024 May; 107(5). doi: 10.35755/jmedassocthai.2024.5.13988. DOI: https://doi.org/10.35755/jmedassocthai.2024.5.13988
Topaktaş R, Altin S, Aydin C, Akkoç A, Ürkmez A, Aydin ZB. Is Spinal Anesthesia an Alternative and Feasible Method for Proximal Ureteral Stone Treatment? Central European Journal of Urology. 2020 Jun; 73(3): 336. doi: 10.5173/ceju.2020.0049. DOI: https://doi.org/10.5173/ceju.2020.0049
Hawker GA, Mian S, Kendzerska T, French M. Measures of Adult Pain: Visual Analog Scale for Pain (Vas Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short‐Form McGill Pain Questionnaire (Sf‐MPQ), Chronic Pain Grade Scale (CPGS), Short Form‐36 Bodily Pain Scale (Sf‐36 Bps), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care and Research. 2011 Nov; 63(S11): S240-52. doi: 10.1002/acr.20543. DOI: https://doi.org/10.1002/acr.20543
Jefferson FA, Findlay BL, Handlogten KS, Gargollo PC, Warner LL, Woodbury JM et al. Spinal Anesthesia in Infants Undergoing Urologic Surgery Duration Greater Than 60 Minutes. Journal of Pediatric Urology. 2022 Dec; 18(6): 786-e1. doi: 10.1016/j.jpurol.2022.07.003. DOI: https://doi.org/10.1016/j.jpurol.2022.07.003
Iqbal A, Saeed SJ, Liaqat K, Ovais F, Qamber JH, Nadia S. Impact of Anesthesia Type on Stone Clearance and Morbidity in Ureteroscopy: General Versus Spinal Anesthesia: Impact of Anesthesia Type on Stone Clearance and Morbidity. Pakistan Journal of Health Sciences. 2025 Jan: 23-9. doi: 10.54393/pjhs.v6i1.2374. DOI: https://doi.org/10.54393/pjhs.v6i1.2374
Cai H, Wu X, Chen X, Chen W. Comparison of the Effects of General, Spinal and Epidural Anesthesia on Ureter Access and Surgical Outcomes During Flexible Ureterorenoscopy for Transurethral Single Stone Removal Surgeries: A Monocentric Retrospective Study. Annals of Medicine. 2021 Jan; 53(1): 2110-9. doi: 10.1080/07853890.2021.1998596. DOI: https://doi.org/10.1080/07853890.2021.1998596
Varghese J, Chang DL, Mirman BD, Capodice J, Shehebar M. Acute and Chronic Pain Management of the Urologic Patient. International Journal of Anesthesia and Critical Care. 2024 May; 3(1): 6-16. doi: 10.33696/Anesthesia.3.008. DOI: https://doi.org/10.33696/Anesthesia.3.008
Imbelloni LE, Sakamoto JW, Viana EP, de Aroujo AA, Pottker D, Pistarino MD. Segmental Spinal Anesthesia: A Systematic Review. Journal of Anesthesia and Clinical Research. 2020; 11(6): 1-6.
Fu G, Xu L, Chen H, Lin J. State-of-the-Art Anesthesia Practices: A Comprehensive Review On Optimizing Patient Safety and Recovery. BioMed Central Surgery. 2025 Jan; 25(1): 32. doi: 10.1186/s12893-025-02763-6. DOI: https://doi.org/10.1186/s12893-025-02763-6
Hernandez NS, Wang AY, Kanter M, Olmos M, Ahsan T, Liu P et al. Assessing the Impact of Spinal Versus General Anesthesia on Postoperative Urinary Retention in Elective Spinal Surgery Patients. Clinical Neurology and Neurosurgery. 2022 Nov; 222: 107454. doi: 10.1016/j.clineuro.2022.107454. DOI: https://doi.org/10.1016/j.clineuro.2022.107454
Mormol JD, Basques BA, Harada GK, Louie PK, Alter K, Goldberg E et al. Risk Factors Associated with Development of Urinary Retention Following Posterior Lumbar Spinal Fusion: Special Attention to the Use of Glycopyrrolate in Anesthesia Reversal. Spine. 2021 Jan; 46(2): E133-8. doi: 10.1097/BRS.0000000000003678. DOI: https://doi.org/10.1097/BRS.0000000000003678
Prabhakar NK, Chadwick AL, Nwaneshiudu C, Aggarwal A, Salmasi V, Lii TR et al. Management of Postoperative Pain in Patients Following Spine Surgery: A Narrative Review. International Journal of General Medicine. 2022 May: 4535-49. doi: 10.2147/IJGM.S292698. DOI: https://doi.org/10.2147/IJGM.S292698
Chitnis SS, Tang R, Mariano ER. The Role of Regional Analgesia in Personalized Postoperative Pain Management. Korean Journal of Anesthesiology. 2020 Oct; 73(5): 363-71. doi: 10.4097/kja.20323. DOI: https://doi.org/10.4097/kja.20323
Zhou L, Yang H, Hai Y, Cheng Y. Perioperative Low‐Dose Ketamine for Postoperative Pain Management in Spine Surgery: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials. Pain Research and Management. 2022; 2022(1): 1507097. doi: 10.1155/2022/1507097. DOI: https://doi.org/10.1155/2022/1507097
Neuman MD, Feng R, Ellenberg SS, Sieber F, Sessler DI, Magaziner J et al. Pain, Analgesic Use, and Patient Satisfaction with Spinal Versus General Anesthesia for Hip Fracture Surgery: A Randomized Clinical Trial. Annals of Internal Medicine. 2022 Jul; 175(7): 952-60.
Capdevila X, Aveline C, Delaunay L, Bouaziz H, Zetlaoui P, Choquet O et al. Factors Determining the Choice of Spinal Versus General Anesthesia in Patients Undergoing Ambulatory Surgery: Results of A Multicenter Observational Study. Advances in Therapy. 2020 Jan; 37(1): 527-40. doi: 10.1007/s12325-019-01171-6. DOI: https://doi.org/10.1007/s12325-019-01171-6
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Health Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments
