C-arm-Guided Paravertebral Block for Surgical Anesthesia in a High-Risk Cardiac Patient Undergoing Percutaneous Nephrolithotomy.

Percutaneous nephrolithotomy (PCNL) is an effective, minimally invasive procedure for removing large or complex renal stones. While general anesthesia is commonly used, it may lead to complications such as hemodynamic instability. This procedure typically involves accessing the kidney through a small incision in the back, where a nephroscope and other instruments are inserted to break up and remove the stones. General anesthesia is standard, but it can cause fluctuations in blood pressure, heart rate, and oxygen levels, which may complicate recovery. In this case, a 51-year-old male with dilated cardiomyopathy and bilateral staghorn renal stones underwent right-sided PCNL under C-arm-guided paravertebral block (PVB) at the T8, T10, and T12 levels. The procedure was successful, with no adverse events and excellent postoperative analgesia. PVB offers a safe alternative to general anesthesia in high-risk cardiac patients, minimizing complications and improving recovery.