Comparison of retrograde intrarenal surgery under regional versus general anaesthesia: A systematic review and meta-analysis

Objective: To assess the current evidence on the effectiveness and safety of retrograde intrarenal surgery (RIPS) under regional anaesthesia (RA) compared with the effectiveness and safety of RIPS under general anaesthesia (GA). Methods: A systematic search was performed using the electronic databases PubMed, Embase, CNKI and the Cochrane Library through May 2020. Two reviewers searched the literature, independently extracted data and evaluated the study quality based on inclusion and exclusion criteria. The data analysis was performed with the software program Review Manager 5.3. Results: Six randomized controlled trials (RCTs) with a total of 580 patients were included in the analysis. The pooled data showed that RIPS under RA achieved a similar stone-free rate (SFR) as that under GA (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.91, 1.02; p = 0.22) but reduced the postoperative visual analogue scale (VAS) score (mean difference (MD) -0.86, 95% CI -1.29, -0.42; p = 0.0001). No significant differences were observed in terms of operation duration (MD 1.71, 95% CI -10.61,14.03; p = 0.79) or hospital stay (MD 0.08, 95% CI -0.18, 0.34; p = 0.54). In addition, the evidence was insufficient to suggest a significant difference in the occurrence of complications associated with RA compared with those associated with GA. Conclusion: Our findings suggest that RA is an effective and safe anaesthesia method for RIPS. Compared with GA, RA is associated with less postoperative pain. Moreover, patients may benefit from RA in terms of economic factors. Nevertheless, large-sample, multi-centric RCTs with strict standards should be performed to confirm these findings.