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Anesthesia

Percutaneous nephrolothotomy

09/05/2008

Question:

I had this procedure done 5 years ago and may have to have it again for a large kidney stone. I had very severe pain starting as soon as I woke up from surgery and required stong IV pain meds for 2 days. I had a C-section with spinal anesthesia and had very tolerable pain afterwards and was able to take just pain pills with very few side effects. I was wondering if this surgery could be done with spinal anesthesia and if so would this reduce the amount of pain. I would really like to avoid the severe pain I had the last time and avoid the IV medicines if possible. Thank you.

Answer:

A spinal anesthetic wears off within minutes to hours of the termination of the procedure. I don't think the difference in the degree and duration of pain you experienced with your C-section and the kidney procedure have much to do with the anesthetic technique. It is much more likely to do with the different nature of the two surgical procedures. A spinal anesthetic is feasible for most abdominal surgeries, however for kidney surgery the block has to be pretty high and spinal anesthesia is therefore not a common choice for this type of procedure. Be sure to discuss your concerns with your anesthesiologist so there can be a plan to treat, or even prevent, your pain. Multimodal analgesia is the concept of attacking the pain at various points in the pain "pathway" - combinations of regional anesthesia (nerve blocks, spinal, epidural), with opioids (strong pain killers like morphine and fentanyl), anti-inflammatory medications, and other drugs and non-drug therapies can be very effective.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University