Outcomes of Retrograde Intrarenal Surgery Performed Under Neuraxial vs. General Anesthesia: An Updated Systematic Review and Meta-Analysis

Abstract

BackgroundThe current review aimed to assess if the outcomes of retrograde intrarenal surgery (RIRS) differ with neuraxial anesthesia (NA) or general anesthesia (GA).MethodsThe databases of PubMed, Embase, CENTRAL, ScienceDirect, and Google Scholar were searched up to 3rd December 2021 for randomized controlled trials (RCTs) and observational studies comparing outcomes of RIRS with NA or GA.ResultsThirteen studies involving 2912 patients were included. Eight were RCTs while remaining were observational studies. Meta-analysis revealed that stone free status after RIRS did not differ with NA or GA (OR: 0.99 95% CI: 0.77, 1.26 I2 = 10% p = 0.91). Similarly, there was no difference in operation time (MD: −0.35 95% CI: −4.04, 3.34 I2 = 89% p = 0.85), 24 h pain scores (MD: −0.36 95% CI: −0.96, 0.23 I2 = 95% p = 0.23), length of hospital stay (MD: 0.01 95% CI: −0.06, 0.08 I2 = 35% p = 0.78), Clavien-Dindo grade I (OR: 0.74 95% CI: 0.52, 1.06 I2 = 13% p = 0.10), grade II (OR: 0.70 95% CI: 0.45, 1.07 I2 = 0% p = 0.10) and grade III/IV complication rates (OR: 0.78 95% CI: 0.45, 1.35 I2 = 0% p = 0.37) between NA and GA. Except for grade I complications, the results did not change on subgroup analysis based on study type and NA type.ConclusionOur results suggest that NA can be an alternative to GA for RIRS. There seem to be no difference in the stone-free rates, operation time, 24-h pain scores, complication rates, and length of hospital stay between NA and GA for RIRS. Considering the economic benefits, the use of NA may be preferred over GA while taking into account patient willingness, baseline patient characteristics, and stone burden.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42021295407.

Retrograde intrarenal surgery with central neuraxial blockade versus general anesthesia: A systematic review and meta-analysis

“…Nevertheless, both our findings and previous reviews[ 31 32 ] consistently suggest that visceral movements have minimal effect on rates of stone clearance. During NA patients can be instructed to hold their breath, aiding stone disintegration.…”

“…Similar outcomes were observed in a study conducted by Duan et al . [ 31 ] where they compared the results of RIRS accomplished under NA or GA by pooling data from 13 studies, providing more current evidence than previous reviews, which often included only six studies. [ 32 33 ] In their study of primary outcome analysis, involving data from 2,912 patients, they found no significant difference in rates of stone clearance status afterward surgery under NA or GA.…”

“…Similar to rates of stone clearance rates, Duan et al . [ 31 ] found no significant difference between NA and GA in terms of operation time. This contrasts with Wang et al .’s review[ 33 ] which stated shorter operating times with NA but aligns with the outcomes of Luo et al .…”

Impact of Preoperative Video-Based Education on Anxiety Levels in Patients with Renal Stones Scheduled for Flexible Ureteroscopic Lithotripsy: A Comparative Study Using APAIS and STAI

“…In this surgical method, kidney stones are treated endourologically with a transureteral approach using flexible ureterenoscopes. Although RIRS is minimally invasive, some complications can develop related to surgery or anesthesia [ 6 , 7 ]. Renal colic, pyelonephritis, hematuria, and acute urinary retention can occur as early complications.…”