The effect of levobupivakaine during spinal anaesthesia on the patients undergoing percutaneous nefrolithotomy

We aimed to evaluate the efficiency of levobupivacain as a spinal anesthetic used in percutaneous nephrolitotomia operations, hemodynamic alterations, patient and surgeon satisfaction.The study is achieved with 58 individuals treated with PCNL operation between the age of 18-65 in Universty of Dicle faculty of medicine ASA I-II. Before the procedure we obtained vascular access from both hand dorsum using branule no:20 of each patient and evaluated both puls rate and blood pressure. Before 30 minutes of application, we deliwered 500 ml Hidroksi asetil and 10 ml/kg isotonic iv. 5 ml/kg/h isotonic solution was deliwered by the time the surgical operation is lasted. Subsequent the monitorization, we deliwered 0.05 mg/kg midazolam to all subjects. All the patient's SAB, DAB, OAB, KAH were recorded. Spinal anesthesia was aschieved each patient in aseptic conditions, in sitting position, by 26 gauce spinal needle and entering from L2-L3 separation. 18 mg levobupivacain and 20 mcg fentanyle with a total dose of 4 cc were injected to sunarachnoidal cavity. After the procedure of spinal anesthesia all patients were lied down and SAB, DAB, OAB, KAH were recorded at 2., 4., 6., 8. minutes than recorded at 5 minutes interval. T4 accession time was evaluated by pin prick test. The surgical operation was initiated at the time the sensorial block got at T4 level. All patients were deliwered 3lt/min. oxygen by oxygen mask by the duration of surgical operation. Sedation levels, motor block levels ( shortly after prone position), patient and surgeon satisfaction were evaluated by Ramsey sedation scale, Modified Bromage scale and VAS respectively. Datas were evaluated by SPSS programme by windows 10.0 statistical packet. İn comparision, Independent Samples Test, N Par Test, Mann Whitney U Test ve Pearson Correlation tests were used P<0.05 was regarded as significant.The average age of males and females were 38.18 and 43.79 years respectively. The average height of male and female were 171.24 cm and 162.25 cm respectively. The average weight of males was 75.06 kg and that of females was 73.88 kg.The average diameter of calcules was 23.19 mm. According to increment of calcule diameter, the duration of operations were longer and this data was statistically significant (p<0.05). The average ramsey sedation scale was 2.67. We obtained increment in patient convenience by increasing in sedation level. This result was statistically significant (p<0.05).The sensorial block accessed to T4 level in average 4.09 minutes after spinal anesthesia was made. The increment of patient's heights was resulting longer sensorial block acces time to T4 level and this result was statistically significant (p<0.05). The access of sensorial block to T4 level was shorter as the body weight increment but this result was not statistically significant (p>0.05). The average access time of sensorial block to T4 level was 3.24 minutes for females and 4.68 minutes for males. The average access time of sensorial block to T4 level was shorter in females but this was statitically not significant. We observed hipotension in 14 subjects (%24.21) and was regarded significant statistically (p<0.05). We administered efedrin to subjects who had hipotension. The hipotension was fewer observed as body strenght increases and this result was statistically significant (p<0.05). As the sedation rate increases we observed more hipotension (p<0.05).Atropin was performed to patients we observed bradicardia ( n:4, %6,9) but this was statistically not significant.At 2 patients (%3.4) in spinal anesthesia, because of unability to find the calcule localisation, open surgical operation was performed. This result ws not statistically significant. The general anesthesia was performed in one of this 2 patients (%1.17) but this was not statistically significant (p>0.05). One patients open surgical operation was carried on in spinal anesthesia but no complication was observed. 3 patients (%5.2) complained about pain and these were performed iv fentanyle. Additional fentanyle dose administration was statistically not significant (p>0.05). The average surgical duration was 60.65 minutes and 60.42 minutes for males and females respectivelly but this was not statistically significant (p>0.05).The average patient convenience by VAS was 9.12 and 9.16 for males and females respectivelly. We observed decrement in patient convenience as the surgical duration extends and this was statistically accepted as significant (p<0.05). The surgeon convenience was 9.76 by VAS.As a result, for lower and middle zone calcules of kidney, we observed good concert at patient and surgeon both, also adequate patient and surgeon satisfaction was observed at subjects had small renal calcules and who were tought to have shorter surgical duration of percutaneous nephrolitotomia by levobupivacaine. We observed significant hipotension in our subjects. For this reason, we agree that wide-ranging and more patients including dose studies are needed.