Flexible ureterorenoscopy and laser lithotripsy with regional anesthesia vs general anesthesia: A prospective randomized study

Abstract

Purpose: To compare the effect of general anesthesia (GA) and regional anesthesia (RA) on fURS outcomes and surgeon comfort. Material and Methods: The study was conducted between June 2017 to January 2018 and data collection was applied in a prospective, randomized fashion. 120 patients participated in the study and were divided into RA group (n=56) and GA group (n=64). Demographic, operative and post-operative parameters of patients were analysed. The end point of this study was the effect of two anesthesia regimens on the comfort of the surgeon, and the comparability of feasibility and safety against perioperative complications. Results: The study including 120 randomized patients, 14 patients were excluded from the study and completed with 106 patients (45 in RA group and 61 in GA group). No difference was detected between the two groups in terms of preoperative data. During the monitorization of operative vital signs, 3 patients in RA group experienced bradycardia, and this finding was significant when compared with GA group (p=0.041). Additionally, 2 patients in RA group experienced mucosal tears and 1 patient experienced hemorrhage during the operation, but no complications were observed in the GA group (p=0.041). Postoperative surgeon comfort evaluation revealed statistically significant results in favor of GA group (p=0.001). Conclusions: Both GA and RA are equally effective and safe anesthesia methods for fURS procedures. However, RA group showed significantly increased likelihood of bradycardia and mucosal injury during surgery, and significantly decreased surgeon comfort during surgery.

The Use of Spinal Anaesthesia for Retrograde Uretero-Renoscopy during the COVID-19 Pandemic

“…The rates of conversion are similar to the figures published in the literature. [8][9][10] There is a practical concern that SA takes longer than GA, which was reflected in our study with SA taking on average 9 mins longer to administer than GA (SA 26 mins, GA 17 mins) (see Figure 2). This did not impact on the number of achievable cases in a session (6-8/day).…”

“…Nevertheless, SA has been widely adopted for perc u t a n e o u s n e p h r o l i t h o t o m y , a n d t h e r e a r e s e v e r a l i n t e r n a t i o n a l p a p e r s s h o w i n g t h e a d v a n t a g e s f o r uretero-renoscopy. [8][9][10] T h e r e a r e n o t a b l e b e n e fi t s t o SA with lower risk of aspiration pneumonia, deep vein thrombosis and cardiopulmonary complications. 11 These are particularly relevant for urology patients who often have significant co-morbidities.…”

“…We did not record the operative comfort of surgery, though this has been assessed in other studies. 8 Stone completion rate was determined by the surgeon at the time of surgery. If the surgeon felt there were significant residual fragments, the patient was re-listed for further procedure.…”

Ureteroscopy under conscious sedation: A proof-of-concept study

“…[21][22] However, there may still be a higher risk of complications when using SA compared to GA for URSs. 23 Additionally, the induction and recovery times are long when using SA. 3 There is scarce evidence comparing SA to loco-sedative anesthesia.…”

Outcomes of Retrograde Intrarenal Surgery Performed Under Neuraxial vs. General Anesthesia: An Updated Systematic Review and Meta-Analysis

“…Fourteen articles were retrieved for full-text analysis of which one was excluded as it compared peripheral nerve block with GA. Finally, a total of 13 studies were included in this systematic review and metaanalysis (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29).…”