Regional versus General Anesthesia for Percutaneous Nephrolithotomy: A Meta-Analysis

Henglong Hu; Baolong Qin; Deng He; Yuchao Lu; Zhenyu Zhao; Jiaqiao Zhang; Yufeng Wang; Shaogang Wang

doi:10.1371/journal.pone.0126587

Regional versus General Anesthesia for Percutaneous Nephrolithotomy: A Meta-Analysis

PLoS One. 2015 May 11;10(5):e0126587. doi: 10.1371/journal.pone.0126587. eCollection 2015.

Authors

Henglong Hu¹, Baolong Qin¹, Deng He¹, Yuchao Lu¹, Zhenyu Zhao¹, Jiaqiao Zhang¹, Yufeng Wang¹, Shaogang Wang¹

Affiliation

¹ Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Abstract

Objective: To compare the effectiveness and safety of regional anesthesia (RA) and general anesthesia (GA) for percutaneous nephrolithotomy (PNL).

Patients and methods: PubMed, 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.

Results: Eight 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.

Conclusions: Current 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.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Anesthesia, Conduction / methods*
Anesthesia, General / methods*
Controlled Clinical Trials as Topic
Humans
Nephrostomy, Percutaneous / methods*
Operative Time
Randomized Controlled Trials as Topic

Grants and funding

This work was supported by the National Natural Science Foundation of China (Grant No. 81270787). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.