What are the considerations for Double J (Ureteral) stent insertion under Spinal Anesthesia?

From the Guidelines

The insertion of a double J stent under spinal anesthesia is a procedure that requires careful consideration of the patient's overall health and the potential risks associated with the procedure, particularly in relation to antithrombotic therapy 1 and neuraxial anesthesia 1.

Key Considerations

• Patient Monitoring: The patient's vital signs should be closely monitored during the procedure, which typically requires 30-60 minutes to complete.
• Anesthesia Management: The procedure usually utilizes 2-3 mL of 0.5% bupivacaine or 2-3 mL of 1% lidocaine for spinal anesthesia, administered at a dose of 5-10 mg and 20-30 mg, respectively.
• Post-Procedure Care: Post-procedure, patients are typically observed for 1-2 hours to ensure adequate recovery from the spinal anesthesia and to assess for any potential complications related to the stent insertion.

Important Factors

• Intrathecal Catheter Placement: The placement of an intrathecal catheter after inadvertent dural puncture requires careful consideration, including the use of aseptic precautions and clear labeling of the catheter 1.
• Communication and Handover: Clear communication and handover of the patient's care are crucial to ensure the safe management of the intrathecal catheter 1.
• Risk of High- or Total-Spinal Anesthesia: The risk of high- or total-spinal anesthesia should be carefully managed, particularly when topping-up an intrathecal catheter 1.

Best Practices

• Use of Vasoconstrictors and Fluids: The use of vasoconstrictors and fluids should be tailored to individual patient requirements to manage hypotension 1.
• Clear Labeling and Documentation: The intrathecal catheter should be clearly labeled and documented in the patient's record to prevent accidental administration of epidural doses 1.

From the Research

Considerations for Double J (Ureteral) Stent Insertion

Anesthesia Technique

• Spinal anesthesia is a safe and effective procedure for lumbar spinal stabilization surgery, especially in high-risk patients 2
• Unilateral spinal anesthesia is a cost-effective and rapidly performed anesthetic technique that offers the advantages of a spinal block without the typical adverse side effects seen with a bilateral block 3
• Local anesthesia is a feasible option for double J stent insertion, and self-watching and detailed explanation to patients can reduce the pain and anxiety associated with the procedure 4

Pain Management

• Preprocedural diclofenac can be effective in pain relief in patients undergoing double J stent removal under local anesthesia 5
• The use of intraurethral lignocaine gel can also help reduce pain during the procedure 5

Urinary Retention

• Urinary retention is a potential complication of spinal anesthesia, but the incidence can be low with proper precautions 2, 6
• The use of a urinary catheter may not be necessary for all patients undergoing procedures under spinal anesthesia, and a selective approach can be considered 6

Patient Monitoring

• Patients undergoing double J stent insertion under spinal anesthesia should be closely monitored for complications associated with the anesthesia technique, including hypotension and bradycardia 2
• Vital signs and duration of the procedure should be documented, and patients should be asked to report any pain or discomfort 4