https://doi.org/10.4081/aiua.2023.11584

Is quadratus lumborum block combined with low dose-spinal anesthesia an effective alternative to general anesthesia in patients undergoing percutaneous nephrolithotomy?

Vol. 95 No. 3 (2023)
Submitted: July 12, 2023
Accepted: August 1, 2023
Published: September 12, 2023
Quadratus lumborum block, Low dose spinal anesthesia, Percutaneous nephrolithotomy
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PDF: 347
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Authors

Tamer A. Abouelgreed
dr_tamer_ali@yahoo.com
https://orcid.org/0000-0003-2640-3425
Department of Urology, Faculty of medicine, Al-Azhar University, Cairo, Egypt.
Ahmed M. Elgarhy
Department Anesthesia, Al-Azhar University, Cairo, Egypt.
Adel Elatreisy
Department of Urology, Faculty of medicine, Al-Azhar University, Cairo, Egypt.
Tamer M. Ewieda
https://orcid.org/0009-0002-8116-0577
Department Anesthesia, Al-Azhar University, Cairo, Egypt.
Wael M. Ibrahim
https://orcid.org/0009-0009-1768-7463
Department Anesthesia, Al-Azhar University, Cairo, Egypt.
Othman Saadeldien Yahia
Department Anesthesia, Al-Azhar University, Cairo, Egypt.
Ahmed M. Elnaggar
https://orcid.org/0009-0002-4931-9090
Department Anesthesia, Al-Azhar University, Cairo, Egypt.
Mohamed A. Elbadawy
https://orcid.org/0009-0000-1964-6539
Department Anesthesia, Al-Azhar University, Cairo, Egypt.
Ali A. Alkumity
Department Anesthesia, Al-Azhar University, Cairo, Egypt.
Yasser Badran
Department of Urology, Faculty of medicine, Al-Azhar University, Cairo, Egypt.
Mahmoud Ali
Department of Urology, Faculty of medicine, Al-Azhar University, Cairo, Egypt.
Aly Gomaa
Department of Urology, Faculty of medicine, Al-Azhar University, Cairo, Egypt.
Mohame. F. Elebiary
https://orcid.org/0009-0007-5704-3916
Department of Urology, Faculty of medicine, Al-Azhar University, Cairo, Egypt.
Mahmoud Aboelnasr
Department of Urology, Faculty of medicine, Al-Azhar University, Cairo, Egypt.

Background: General anesthesia in high-risk patients has many complications and needs long preoperative preparations and postoperative intensive care unit (ICU). Therefore the present study aimed to evaluate the efficacy of combined low-dose spinal anesthesia with quadratus lumborum block (QLB) as an alternative to general anesthesia for patients undergoing percutaneous nephrolithotomy. Patients and methods: A prospective study was conducted at the urology department of Al-Azhar University Hospitals in Cairo, Egypt, from January 2021 to January 2022. The study included 60 patients of ASA ll-lll scheduled for percutaneous nephrolithotomy. All patients received low-dose spinal anesthesia (5 mg bupivacaine) and QLB (QL1-QL2-QL3) approaches. The primary observation parameter was the efficacy of this technique as an alternative to general anesthesia. The secondary parameters measured were evaluation of need for intraoperative narcotics, postoperative pain score (VAS), and patients satisfaction as assessed using a 5-point Likert Scale. Results: None of the patients was given general anesthesia, and intraoperative sedation was given to nineteen patients (32.2%). No hemodynamic changes were observed in all patients. There was a significant correlation between the use of intraoperative sedation and stone site, intraoperative blood loss, and hospital stay. Pain intensity on VAS at rest and movement was low until the 24th postoperative hour. Patient satisfaction score was 3, 4, and 5 in 1 (1.7%), 4 (6.7%), and 55 (91.6%) patients, respectively. Conclusions: Combined low-dose spinal anesthesia with quadratus lumborum block is an effective alternative to general anesthesia in patients undergoing PCNL procedures with good postoperative analgesia. Patients with lower calyceal punctures have a lower incidence of intraoperative sedation requirements.

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How to Cite

Abouelgreed, T. A., Elgarhy, A. M., Elatreisy, A., Ewieda, T. M., Ibrahim, W. M., Yahia , O. S., Elnaggar , A. M., Elbadawy , M. A., Alkumity , A. A., Badran , Y., Ali , M., Gomaa, A., Elebiary, M. F., & Aboelnasr , M. (2023). Is quadratus lumborum block combined with low dose-spinal anesthesia an effective alternative to general anesthesia in patients undergoing percutaneous nephrolithotomy?. Archivio Italiano Di Urologia E Andrologia, 95(3). https://doi.org/10.4081/aiua.2023.11584
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