Retrograde Intrarenal Surgery with Combined Spinal-Epidural vs General Anesthesia: A Prospective Randomized Controlled Trial

Abstract

Retrograde intrarenal surgery (RIRS) involves a minimally invasive stone surgery, lending itself potential to combined spinal-epidural anesthesia (CSEA), although it is performed preferably under general anesthesia (GA). This prospective randomized study was undertaken to evaluate the feasibility and efficacy of CSEA for patients undergoing RIRS. Seventy consecutive patients who were scheduled for RIRS were randomized to receive CSEA (n=35) or GA (n=35). Operative time, stone clearance rate, visual analog scale (VAS) of pain, complication rate, anesthetic cost, and hospital stay were compared between the two groups. A total of 65 patients randomized to CSEA (31) or GA (34) completed the study. In the CSEA group, each procedure was completed and there was no anesthetic conversion. Although based on the prospective randomized method, the GA group still had a little larger stone size (p=0.059) and more multiple caliceal stones (p=0.037). Overall, there were no statistically significant differences in operative time (p=0.088), stone fragmentation time (p=0.074), postoperative VAS pain score at 6 and 24 hours (p=0.156, 0.146), incidence of complications (p=0.870), stone-free rate (p=0.804), and hospital stays (p=0.907) between the two groups. The patients in the GA group experienced a higher mean hemoglobin drop (6.5±3.2 vs 8.6±2.7 g/L, p=0.012). In addition, the anesthetic cost was much cheaper in the CSEA group (183.8±31.4 vs 391.9±59.1 dollars, p<0.001). RIRS with CSEA can be completed with no anesthetic conversions and with the same efficacy and safety compared with GA. When considering economical aspects, CSEA appears to be a preferable alternative to GA for the patient whose general health status permits it.