Does the type of anaesthesia influence the outcome of percutaneous nephrolithotomy? Outcomes from a meta- analysis of randomized controlled trials

Objective

To systematically review the outcomes of percutaneous nephrolithotomy (PCNL) performed in local (LA) or regional anesthesia (RA) as compared to general anesthesia (GA).

Methods

Literature search was conducted on 12th April 2024 including PubMed, Medline, Embase, and Scopus database. Complications were assessed using the Cochran-Mantel-Haenszel Method with the random effect model and reported as odds ratio (OR), 95% confidence interval (CI), and p-values. Analyses were two-tailed and the significance was set at p < 0.05 and a 95% CI. Continuous variables were pooled using the inverse variance of the mean difference with a random effect, 95% CI, and p-values.

Results

Fourteen studies were included. Overall, there were 1413 patients, with 703 patients in the LA/RA group and 710 in the GA group. There was no difference in Clavien grade III and ≥III complications, postoperative pain, postoperative headache, operative time, postoperative stay, stone-free rate, and intraoperative mean heart rate between LA/RA and GA. Meta-analysis shows that the nausea and vomiting rate favors the LA/RA group (OR 0.10), blood transfusion rate is lower in LA/RA group (OR 0.40), intraoperative blood loss is lower in LA/RA group (MD −59.63 ml) and intraoperative mean arterial pressure is lower in LA/RA group (MD −10.80 mmHg).

Conclusions

This meta-analysis shows no difference in stone-free and complication rates or hospital stay if PCNL is done under GA or LA/RA. LA/RA offers advantages for better intraoperative hemodynamic stability with lesser post-operative nausea and vomiting. PCNL under RA adoption in clinical practice is perhaps limited to centers where specialist anesthetist services can support this procedure.