Influence of anesthesia methods on surgical outcomes and renal function in retrograde intrarenal stone surgery: a prospective, randomized controlled study

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

Objective

The aim of the article is to assess the impact of retrograde intrarenal surgery under central neuraxial blockade in comparison to general anesthesia (GA).

Material and Methodology

This systematic review was conducted following the guidelines set out by the preferred reporting items for systematic reviews and meta-analyses. We conducted a comprehensive search across major electronic databases, including various types of studies such as descriptive studies and full-text literature, all of which were incorporated into the current review from 2018 to 2023. We involved those studies, which included the comparative study of spinal anesthesia (SA), epidural anesthesia (EA), and combined spinal epidural anesthesia with GA.

Result

In our meta-analysis of 12 studies, it was found that anesthesia technique significantly affected operation time, with neuraxial anesthesia (NA) showing a mean difference of -2.28 (95% confidence interval (CI): -3.5 to -1.04, P = 0.003) compared to GA. However, there were no significant differences in rates of stone clearance, 24-h pain scores and length of hospital stay among patients administered with NA or GA for retrograde intrarenal surgery (RIRS).

Conclusion

On the basis of the outcomes of study, NA can serve as a viable alternative to GA for RIRS. Our analysis reveals no significant differences in rates of stone clearance, operation duration, 24-h pain scores, complication rates, and length of hospital stay between NA in addition to GA in the context of RIRS. This suggests that given the potential economic advantages, NA might be a preferable choice over GA, contingent on patient preferences, baseline characteristics, and stone burden.

Effects of Subcostal Anterior Quadratus Lumborum Block with and without Dexmedetomidine on Postoperative Rehabilitation in Patients Undergoing Laparoscopic Renal Surgery: A Prospective Double-Blinded Randomized Controlled Study

Background

The combination of different anesthesia techniques or adjuvant drugs can relieve the stress response to surgery, reduce adverse reactions and improve the clinical outcome. We investigated the effects of subcostal anterior quadratus lumborum block (SQLB) with and without dexmedetomidine (DEX) on postoperative rehabilitation for laparoscopic renal surgery (LRS).

Methods

We included 90 patients in this single-center study. All were scheduled for elective laparoscopic radical or partial nephrectomy under general anesthesia (GA). We randomly and evenly assigned them to three groups: Group GA (GA alone), Group QG (SQLB with 30 mL of 0.25% ropivacaine and GA), and Group DQG (SQLB with 30 mL of 0.25% ropivacaine plus 1 μg/kg DEX and GA). The primary outcomes were serum creatinine (Cr) and blood urea nitrogen (BUN) levels; the secondary outcomes included the average numeric rating scale (NRS) scores at rest and during activity within 48 h postoperatively; perioperative opioid consumption; the time to first ambulation, exhaust, and fluid intake, and postoperative adverse reactions.

Results

The serum Cr and BUN levels in Group DQG decreased significantly compared with Group GA (P < 0.05). The average NRS scores in Group DQG were significantly lower than other two groups (P < 0.05). Furthermore, the indexes reduced significantly in Group QG compared with Group GA (P < 0.05). Groups DQG and QG had lower consumption of opioid compared with Group GA (P < 0.05). The recovery indicators in Groups DQG and QG were higher quality than Group GA (P < 0.05). The incidences of adverse reactions in Group DQG was significantly lower than the other groups (P < 0.05).

Conclusion

SQLB with and without DEX could attenuate postoperative pain, reduce opioids requirement and side effects, as well as facilitate postoperative early rehabilitation. More interesting, SQLB with DEX could confer kidney protection.

Clinical Trial Registration Number

The Chinese Clinical Trial Registry (ChiCTR2200061554).

Effective and Economical Option of Anesthesia in Retrograde Intrarenal Surgery

Background

There is only limited data in the literature showing the effect of anesthesia methods on the success of retrograd intrarenal surgery. The aim of this study was to compare and evaluate retrograd intrarenal surgery cases performed under spinal and general anesthesia in terms of effectiveness, cost, hospitalization time and complications.

Methods

A total of 337 patients who underwent retrograd intrarenal surgery due to kidney stones between 2014 and 2019 were retrospectively evaluated. In our study, the patients were divided into two groups according to the anesthesia method administered: Group 1 consisted of 172 patients who received spinal anesthesia and Group 2 comprised 165 patients administered general anesthesia. Both groups were compared in terms of demographic data, localization and size of stone, radiographic stone density, operation time, complications, need for postoperative analgesia, length of hospitalization, and stone free rate.

Results

The cost of general anesthesia was significantly higher compared to that of spinal anesthesia (p < 0.001). The analgesia application administered within the first six postoperative hours was significantly higher in the general anesthesia group (p < 0.001). In other findings, there was no statistically significant difference between the two groups.

Conclusion

Retrograd intrarenal surgery can be performed with similar safety and effectiveness under both general and spinal anesthesia. However, spinal anesthesia seems to be more advantageous due to the patients' lower need for analgesics in the early postoperative period and the lower cost of the anesthetics used.

Indications, preferences, global practice patterns and outcomes in retrograde intrarenal surgery (RIRS) for renal stones in adults: results from a multicenter database of 6669 patients of the global FLEXible ureteroscopy Outcomes Registry (FLEXOR)

PURPOSE

To collect a multicentric database on behalf of TOWER research group to assess practice patterns and outcomes of retrograde intrarenal surgery (RIRS) for kidney stones.

METHODS

Inclusion criteria: age ≥ 18 years, normal renal/calyceal system anatomy, calculi of any size, number, and position.

STUDY PERIOD

January 2018 and August 2021. Stone-free status: absence of fragments > 2 mm, assessed post procedure according to the local protocol (KUB X-Ray and/or ultrasound or non-contrast CT scan).

RESULTS

Twenty centers from fifteen countries enrolled 6669 patients. There were 4407 (66.2%) men. Mean age was 49.3 ± 15.59 years. Pain was the most frequent symptom indication for intervention (62.6%). 679 (10.2%) patients underwent RIRS for an incidental finding of stones. 2732 (41.0%) patients had multiple stones. Mean stone size was 10.04 ± 6.84 mm. A reusable flexible ureteroscope was used in 4803 (72.0%) procedures. A sheath-less RIRS was performed in 454 (6.8%) cases. Holmium:YAG laser was used in 4878 (73.1%) cases. A combination of dusting and fragmentation was the most common lithotripsy mode performed (64.3%). Mean operation time was 62.40 ± 17.76 min. 119 (1.8%) patients had an intraoperative injury of the ureter due to UAS insertion. Mean postoperative stay was 3.62 ± 3.47 days. At least one postoperative complication occurred in 535 (8.0%) patients. Sepsis requiring intensive care admission occurred in 84 (1.3%) patients. Residual fragments were detected in 1445 (21.7%) patients. Among the latter, 744 (51.5%) patients required a further intervention.

CONCLUSION

Our database contributes real-world data to support to a better understanding of modern RIRS practice and outcomes.

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

Background

The current review aimed to assess if the outcomes of retrograde intrarenal surgery (RIRS) differ with neuraxial anesthesia (NA) or general anesthesia (GA).

Methods

The 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.

Results

Thirteen 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.

Conclusion

Our 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 Registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42021295407.

Outcomes of loco-regional anaesthesia in ureteroscopy for stone disease: a systematic review

PURPOSE OF REVIEW

Routine ureteroscopy (URS) for stone disease is performed under a general anaesthesia. However, controversy exists on the role of loco-regional anaesthesia and the outcomes associated with it. Here we review the challenges, outcomes and complications of loco-regional anaesthesia for URS. A Cochrane style review was performed in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines to evaluate the outcomes of loco-reginal anaesthesia for URS in stone disease, including all English language articles from January 1980 and December 2019.

RECENT FINDINGS

Twenty-one studies (1843 procedures) with a mean age of 46 years and a male : female ratio of 1.2 : 1 underwent URS under loco-regional anaesthesia. The mean stone size was 9 mm (range:4-21 mm) and except five papers, all other papers included stones in the ureter of which the majority were in the distal ureter. The conversion to general anaesthesia was needed in 2.7% patients (range 1-21%) across studies, with a stone free rate of 48-100%. The complication rate varied from 1.4 to 36%. Although the intraoperative complications included ureteric injury (n = 21) or perforation (n = 4), the postoperative complications included fever (n = 37), urinary tract infection (n = 20), haematuria (n = 4), urosepsis (n = 4) and others (n = 7).

SUMMARY

The present systematic review shows that local anaesthetic URS is a potential alternative to general anaesthetic URS in carefully selected patients. Randomised controlled trials with subgroup analysis are required to further assess whether loco-regional anaesthesia URS is noninferior to general anaesthesia URS and might help determine if the former approach should become more widespread.

Regional vs General Anesthesia for Retrograde Intrarenal Surgery: A Systematic Review and Meta-Analysis

Purpose: To determine the effectiveness and safety of retrograde intrarenal surgery (RIRS) under regional anesthesia (RA) vs general anesthesia (GA). Methods: In February 2020, a comprehensive search of PubMed, EMBASE, Web of Science, Cochrane Library, ClinicalTrials.gov, and WHO International Clinical Trials Registry was performed to find eligible studies comparing outcomes of GA and RA during RIRS procedure. Result parameters, including stone-free rate (SFR), operation time, postoperative length of stay, postoperative first-day visual analog scale (VAS) score, and complication rates were assessed using RevMan 5.3. Results: Six studies (five randomized controlled trials and one retrospective study) with 1747 individuals were included. Pooled results revealed no statistical difference exist concerning SFR (odds ratio [OR] = 1.07, p = 0.63), postoperative length of stay (weighted mean difference [MD] = 0.08, p = 0.54), postoperative first-day VAS score (MD = -0.10, p = 0.23), and complication rates (OR = 0.91, p = 0.46). However, the RA group had shorter operation time (MD = -5.41, p < 0.00001) compared with GA group. Conclusion: The present study showed that RA demonstrated shorter operation time than GA, and was similar to GA regarding SFR, postoperative length of stay, postoperative first-day VAS score, and complication rates. We considered that RA might be a better alternative with prudent patient selection.