Peroperative renal pain lower in upper spinal block of proximal (upper) ureteric stone management by URS + ICPL under spinal anesthesia
Abstract
Introduction: Proximal (upper) Ureteric stone management by URS + ICPL under Spinal Anesthesia; Upper Spinal Block (USAB) reduces / lowers the Renal pain than Lower Spinal Block (LSAB). Objective: To ensure patients compliance and or to reduce renal and flank pain due to high irrigation fluid pressure and or due to rigid ureteroscopy through ureter during URS + ICPL of Upper ureteric stone operation under Spinal Anesthesia. Material & Methods: Randomized prospective study of 60 patients admitted in National Institute of Kidney Diseases & Urology (NIKDU), Dhaka, Bangladesh from early January 2019 to late January 2020 with the diagnosis of proximal (upper) ureteric stone for URS + ICPL under Spinal Anesthesia. Demographic study of the patients age, sex, ASA Score having no spinal deformity. Every patient was properly informed & counselled about the whole procedures & outcomes including Spinal anesthesia (SAB) and URS +ICPL. Written informed consent was taken from all patients and their legal guardians as well. Patients with contraindications to SAB (Coagulopathy, local infection. etc.), allergies to local anesthetic sol, opioids, drugs used, and significant spine, hepatic, cardiovascular, respiratory or psychiatric disorders were excluded from the study. Results: 60 patients were randomly selected of which 30 pt's selected for Group-A and 30 pt's for Group B. Finally, 26 patients in each Group i.e., total 52 patients were done URS+ICPL under SAB subject for our study. 13 Patients had complained of mild to moderate pain (VAS: 0-6) of which 4 patients Group: A and 9 patients Group: B. In Group: A; 2 of 4 pt's had complained of mild pain (VAS:<3) and required analgesic i.e., Inj ketorolac 30mg IV & 2 pt's had complained of moderate pain (VAS: >3-6) required potent analgesic i.e., Inj Pethidine 50mg IV slowly in addition to Inj ketorolac 30mg. In Group: B; 5 of 9 pt's had complained of mild pain (VAS:<3) and required analgesic i.e. Inj ketorolac 30mg IV & 4 pt's had complained of moderate pain (VAS:>3-6) required potent analgesic i.e. Inj pethidine 50mg IV slowly in addition to IV Inj ketorolac 30mg. 8 patients had developed hypotension of which 6 in Group: A where 3 pt's had developed moderate hypotension and required vasopressor (Inj Ephedrine HCl 10-30mg) with the increased IV fluid respectively & 3 pt's had developed mild hypotension hadn't got vasopressor but got increased IV fluid. And 2 pt's in Group: B had developed mild hypotension hadn't gotten any vasopressor but got increased IV fluid. 5 Patients had developed bradycardia (HR: >45-60 beat/min) of which 4 in Group: A & 1in Group: B had required inj Atropine 0.3-0.6mg. 14 Patients had developed tachycardia (HR: >90 beat/min) of which 5 in Group: A & 09 in Group: B. The tachycardia was usually accompanied by pain during procedures & little with hypotension. 3 Patients developed little anorexia without vomiting of only Group: A & neither of Group: B following moderate hypotension & bradycardia which were managed respectively.
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