The efficacy and safety of percutaneous nephrolithotomy under general versus regional anesthesia: a systematic review and meta-analysis

This meta-analysis was performed to evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) under regional anesthesia (RA) vs. general anesthesia (GA). A systematic literature search in the electronic databases (Cochrane CENTRAL, Medline and EMBASE) was performed up to April 2014. Twelve trials, including 1954 patients, met the inclusion criteria and were included in the final analysis. Our pooled analysis showed that PCNL under RA could reduce surgical duration (MD, −2.47; 95 % CI, −3.51 to −1.44), hospitalization period (MD, −0.48; 95 % CI −0.93 to −0.04), fluoroscopy time (MD, −0.48; 95 % CI, −0.83 to −0.14), blood transfusion (OR, 0.59; 95 % CI, 0.38–0.92), postoperative pain (MD, −1.99; 95 % CI, −2.2 to −1.78), and analgesic requirements (MD, −19.14; 95 % CI, −26.64 to −11.63). However, there was no difference between RA and GA groups with regard to stone-free rate (OR, 1.09; 95 % CI, 0.86–1.37) and postoperative complications associated with PCNL (OR, 0.95; 95 % CI 0.58–1.54). Our results show that PCNL under RA offers several potential advantages over GA in terms of surgical duration, hospitalization period, fluoroscopy time, blood transfusion, postoperative pain, and analgesic requirements, but both anesthetic techniques appear to be equivalent with regard to the stone-free rate and complication rate. Along with the suggested favorable hemodynamic profile and lower cost, RA may prove a better alternative than GA.