Sarcouncil Journal of Medicine and Surgery

Abstract: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for renal calculi of large size, traditionally performed in the prone position under general anesthesia, which the supine position has been proposed as an alternative, potentially offering logistic and physiological benefits, but relative efficacy and safety, particularly with spinal anesthesia whereby our study compared the safety and efficacy profiles of supine and prone positions for PCNL with spinal anesthesia. Furthermore, a cross-sectional study was performed in 95 patients (49 supine, 46 prone) who underwent PCNL under spinal anesthesia at the Baghdad, Iraq hospitals during 12 12-month follow-up from June 2024 to June 2025. Also, both groups were not different in demographic factors, preoperative factors, and stone burden, as well as our findings evaluated were operative time, stone-free rate (SFR), hemodynamic stability, complications, postoperative pain, and hospital stay. These results found that supine position had associated with highly decreased operative time (58.2 ± 11.2 min vs. 127.7 ± 24.3 min) and faster time to stabilize blood pressure after anesthesia (6.2 ± 1.5 min vs. 8.7 ± 1.3 min), while supine position had a non-significant trend of higher SFR (93.5% vs. 81.6%) and significantly lower hospital stay (2.5 ± 0.9 days vs. 3.8 ± 0.7 days). However, the supine group produced lower pain scores postoperatively at six hours (VAS 2.4 ± 1.5 vs. 5.2 ± 1.2) and more intraoperative hemodynamic stability (91.84% vs. 73.91%) alongside with complications between the groups were statistically similar, where it found supine position has certain advantages in terms of reduced operative time and superior early postoperative pain control, while prone position may lead to reduced hospital stay, where choice of position needs to be individualized, weighing trade-offs between operating efficiency and specific postoperative recovery factors.