Duan Mingda, Chen Yu, Sun Li
Department of Anesthesiology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China.
Department of Anesthesiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China.
Front Surg. 2022 Mar 10;9:853875. doi: 10.3389/fsurg.2022.853875. eCollection 2022.
The current review aimed to assess if the outcomes of retrograde intrarenal surgery (RIRS) differ with neuraxial anesthesia (NA) or general anesthesia (GA).
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.
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 I = 10% = 0.91). Similarly, there was no difference in operation time (MD: -0.35 95% CI: -4.04, 3.34 I = 89% = 0.85), 24 h pain scores (MD: -0.36 95% CI: -0.96, 0.23 I = 95% = 0.23), length of hospital stay (MD: 0.01 95% CI: -0.06, 0.08 I = 35% = 0.78), Clavien-Dindo grade I (OR: 0.74 95% CI: 0.52, 1.06 I = 13% = 0.10), grade II (OR: 0.70 95% CI: 0.45, 1.07 I = 0% = 0.10) and grade III/IV complication rates (OR: 0.78 95% CI: 0.45, 1.35 I = 0% = 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.
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.
https://www.crd.york.ac.uk/prospero/, identifier: CRD42021295407.
本综述旨在评估逆行肾内手术（RIRS）在采用神经轴索麻醉（NA）或全身麻醉（GA）时的结果是否存在差异。
检索截至2021年12月3日的PubMed、Embase、CENTRAL、ScienceDirect和谷歌学术数据库，查找比较RIRS采用NA或GA的结果的随机对照试验（RCT）和观察性研究。
纳入了13项涉及2912例患者的研究。其中8项为RCT，其余为观察性研究。荟萃分析显示，RIRS术后结石清除状态在NA和GA之间无差异（OR：0.99，95%CI：0.77，1.26，I=10%，P=0.91）。同样，NA和GA在手术时间（MD：-0.35，95%CI：-4.04，3.34，I=89%，P=0.85）、24小时疼痛评分（MD：-0.36，95%CI：-0.96，0.23，I=95%，P=0.23）、住院时间（MD：0.01，95%CI：-0.06，0.08，I=35%，P=0.78）、Clavien-Dindo I级（OR：0.74，95%CI：0.52，1.06，I=13%，P=0.10）、II级（OR：0.70，95%CI：0.45，1.07，I=0%，P=0.10）和III/IV级并发症发生率（OR：0.78，95%CI：0.45，1.35，I=0%，P=0.37）方面无差异。除I级并发症外，基于研究类型和NA类型的亚组分析结果未发生变化。
我们的结果表明，NA可作为RIRS中GA的替代方案。RIRS采用NA和GA在结石清除率、手术时间、24小时疼痛评分、并发症发生率和住院时间方面似乎没有差异。考虑到经济效益，在考虑患者意愿、患者基线特征和结石负荷的情况下，可能更倾向于使用NA而非GA。
