Abstract
ObjectiveTo compare the effectiveness and safety of regional anesthesia (RA) and general anesthesia (GA) for percutaneous nephrolithotomy (PNL).Patients and MethodsPubMed, EMBASE, The Cochrane Library, and the Web of Knowledge databases were systematically searched to identify relevant studies. After literature screening and data extraction, a meta-analysis was performed using the RevMan 5.3 software.ResultsEight randomized controlled trials (RCTs) and six non-randomized controlled trials (nRCTs) involving 2270 patients were included. Patients receiving RA were associated with shorter operative time (−6.22 min; 95%CI, −9.70 to −2.75; p = 0.0005), lower visual analgesic score on the first and third postoperative day (WMD, −2.62; 95%CI, −3.04 to −2.19; p < 0.00001 WMD, −0.38; 95%CI, −0.58 to −0.18; p = 0.0002), less analgesic requirements (WMD, −59.40 mg; 95%CI, −78.39 to −40.40; p<0.00001), shorter hospitalization (WMD, −0.36d; 95%CI, −0.66 to −0.05; p = 0.02), less blood transfusion (RR, 0.61; 95%CI, 0.41 to 0.93; p = 0.02), fewer modified Clavion-Dindo Grade II (RR, 0.56; 95%CI, 0.37 to 0.83; p = 0.005), Grade III or above postoperative complications (RR, 0.51; 95%CI, 0.33 to 0.77; p = 0.001), and potential benefits of less fever (RR, 0.79; 95%CI, 0.61 to 1.02; p = 0.07), nausea or vomiting (RR, 0.54; 95%CI, 0.20 to 1.46; p = 0.23), whereas more intraoperative hypotension (RR, 3.13; 95%CI, 1.76 to 5.59; p = 0.0001) when compared with patients receiving GA. When nRCTs were excluded, most of the results were stable but the significant differences were no longer detectable in blood transfusion, Grade II and more severe complications. No significant difference in the total postoperative complications and stone-free rate were found.ConclusionsCurrent evidence suggests that both RA and GA can provide safe and effective anesthesia for PNL in carefully evaluated and selected patients. Each anesthesia technique has its own advantages but some aspects still remain unclear and need to be explored in future studies.
Highlights
Percutaneous nephrolithotomy (PNL) has become the main treatment for large or multiple kidney stones, staghorn stones, and cases of failed shock wave lithotripsy
Current evidence suggests that both regional anesthesia (RA) and general anesthesia (GA) can provide safe and effective anesthesia for PNL in carefully evaluated and selected patients
PNL is usually performed under general anesthesia (GA) due to the better control of breathing and more comfort for the patients; all contraindications for GA apply to PNL according to the EAU guidelines on urolithiasis [1]
Summary
Percutaneous nephrolithotomy (PNL) has become the main treatment for large or multiple kidney stones, staghorn stones, and cases of failed shock wave lithotripsy. In the last two decades, several changes and modifications have taken place in an attempt to further refine the procedure and lower the morbidity, analgesic requirements, and duration of hospitalization. One of these changes has been the use of regional anesthesia (RA) including spinal anesthesia (SA), epidural anesthesia (EA), and combined spinal epidural anesthesia (CSEA) in patients who are undergoing PNL [3]. As each type of anesthesia has some advantages and disadvantages and the results of such studies were not entirely consistent; a meta-analysis of the available evidence is needed to find their superiorities for PNL by comparing the outcomes of PNL under RA with those under GA. We hope the results would generate more interest in this topic and provide some help for urologists, anesthesiologists, patients, and policymakers in making relevant decisions in the future
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
