Spinal Versus Epidural Anesthesia for Patients with Chronic Obstructive Pulmonary Disease Undergoing Supine Percutaneous Nephrolithotomy for Management of Renal Stones. A Prospective Double-Blind Randomized Clinical Trial

Background: Regional anesthesia is currently a panacea for preventing or minimizing complications in chronic obstructive pulmonary disease (COPD) patients. Objective: This unique study compared the efficacy and safety of segmental thoracic spinal anesthesia (TSA) versus segmental thoracic epidural anesthesia (TEA) in COPD patients undergoingpercutaneous nephrolithotomy (PCNL) for renal stones removal in the supine position.
Patients and methods: One hundred COPD patients, both sexes, ages 40 to 80, with ASA physical status classes II and III, were prepped for elective PCNL for renal stone. The patients were split into two groups of fifty. One group (TSA) was given segmental thoracic spinal anesthesia while the other group (TEA) was given segmental thoracic epidural anesthesia. Our primary and secondary outcomes were changes in pulmonary PO₂ and PCO₂, incidence of various side effects, postoperative pain severity, characteristics of utilized neuroaxial blockade, and changes in hemodynamics.
Results: When comparing the two groups, we found no statistical significance in terms of demographics, hemodynamics, pulmonary function gains, adverse events, surgeon and patient satisfaction, or postoperative visual analog scale. The onset of the block was quicker and less amount of local anesthetic was needed in the TSA compared to the TEA. Conversely, the incidence of hypotension was higher in the TEA group than in the TSA group.
Conclusion: Our study demonstrated that TSA is easier, safer, and has a faster onset of action, provides a more predictable block, has less hemodynamic instability, and has fewer technical failures compared to TEA.