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

To determine the effectiveness and safety of retrograde intrarenal surgery (RIRS) under regional anesthesia (RA) vs general anesthesia (GA). 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. 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. 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.