Comparison of Percutaneous Nephrolithotomy Under Regional versus General Anesthesia: A Meta-Analysis of Randomized Controlled Trials

Abstract

The aim of the present meta-analysis was to systematically examine the literature and to identify of the results of randomized controlled trials (RCTs) comparing the efficacy and safety of regional anesthesia (RA) versus general anesthesia (GA) for percutaneous nephrolithotomy (PCNL). An exhaustive electronic literature search of PubMed, Embase, and Web of science was performed until March 2018. Nine prospective RCTs concluding 858 patients comparing the use of RA to GA for PCNL were included. Combined results demonstrated that PCNL under RA could reduce operative time (mean difference [MD] -6.20; 95% CI -10.39 to -2.01), hospital stay (MD -0.59; 95% CI -0.74 to -0.45), visual analgesic score on the first and third postoperative day (MD -2.62, 95% CI -3.04 to -2.19 and MD -0.38; 95% CI -0.58 to -0.18) , analgesic requirements (MD -36.84; 95% CI -55.23 to -18.45), and nausea and/or vomiting (relative risk [RR] 0.28; 95% CI 0.13-0.61). There were no significant differences between RA and GA groups in terms of stone-free rate, blood transfusion, and postoperative fever rate. The results of subgroup analysis were basically consistent with the overall findings. Current evidence suggests that RA is an available and safe option in carefully evaluated and selected patients.

Perkutan Nefroli̇totomi̇ Yapilan Hastalarda Farkli Anestezi̇ Yöntemleri̇ni̇n Karşilaştirilmasi

“…Ancak aynı meta-analizde rejyonel anestezi grubunda operasyon, floroskopi ve hastanede kalış sürelerinin daha kısa olduğu, kan transfüzyonu ve analjezik ihtiyacı oranlarının da daha düşük olduğu tespit edilmiştir. Dokuz prospektif çalışma ve 858 hastayı değerlendiren güncel bir meta-analizde de rejyonel anestezi ile yapılan PCNL operasyonlarının daha kısa sürdüğü, hastanede kalış sürelerinin ve postoperatif analjezik gereksinimlerinin anlamlı olarak azaldığı; buna karşın taşsızlık ve kan transfüzyon oranlarının GA ile benzer olduğu saptanmıştır (19). Bizim çalışmamızda da SA ve GA grupları arasında taşsızlık oranları, hastanede kalış süresi, hemoglobin düşüşü ve transfüzyon ihtiyacı açısından anlamlı farklılık saptanmadı.…”

Holmium laser lithotripsy with semirigid ureterorenoscopy in treatment of upper ureteral and renal pelvis stones under spinal anesthesia

“…In the literature, it has been mentioned that PNL and RIRS could be performed with RA. 4,14,18 Besides, it has never been demonstrated that upper ureteral and renal pelvis stones could be treated with semirigid URS under RA so far. In our study, we have indicated that upper ureteral and renal pelvis stones could be fragmented with semirigid URS under RA, especially in sensitive cases.…”

“…The PNL procedure can be safety carried out under both GA and RA, such as spinal anesthesia (SA), combined spinal epidural anesthesia and epidural anesthesia. 4 In general, the special advantages of GA in the PNL procedure may be due to its feasibility to control breathing and improve comfort for the patients. However, there are some complications associated with GA such as atelectasis, drug reactions and post-operative nausea/vomiting.…”

“…However, there are some complications associated with GA such as atelectasis, drug reactions and post-operative nausea/vomiting. 4,5 Moreover, the patients may not accept GA because of several comorbidities or economical concerns. Data established from randomized and controlled trials have indicated that RA has some potential advantages over GA in PNL and RIRS.…”

Treatment of bilateral staghorn nephrolithiasis using percutaneous nephrolithotripsy in a patient chronically infected with Proteus mirabilis: a case report with literature review

“…In patients who are carefully selected, regional anesthesia may be a safe and accessible option. However, there were no significant differences in SFR, transfusion rates or postoperative fever rates [15]. Doo Yong Chung et al sought to compare the SFR results between treatment with RIRS, SWL and also PCNL.…”