Does the type of anaesthesia influence the outcome of Percutaneous nephrolithotomy? Outcomes from a meta- analysis of Randomized Controlled Trials

Objective: To systematically review the outcomes of Percutaneous nephrolithotomy (PCNL) performed in local (LA) or regional anaesthesia (RA) as compared to general anaesthesia (GA). Methods: Literature search was conducted on 12th April 2024 including PubMed, Medline, Embase, and Scopus database. Complications were assessed using the Cochran-Mantel-Haenszel Method with the random effect model and reported as odds ratio (OR), 95% confidence interval (CI), and p-values. Analyses were two-tailed and the significance was set at p < 0.05 and a 95% CI. Continuous variables were pooled using the inverse variance of the mean difference with a random effect, 95% CI, and p-values. Results: Fourteen studies were included. Overall, there were 1413 patients, with 703 patients in the LA/RA group and 710 in the GA group. There was no difference in Clavien grade I-II and ≥ III complications, postoperative pain, postoperative headache, Operative Time, postoperative stay, stone-free rate, and intraoperative mean heart rate between LA/RA and GA. Meta-analysis shows that the Nausea and Vomiting rate favors the LA/RA group (OR 0.10), Blood Transfusion rate is lower in LA/RA group (OR 0.40), Intraoperative Blood Loss is lower in LA/RA group (MD -59.63 ml) and Intraoperative Mean Arterial Pressure is lower in LA/RA group (MD -10.80 mmHg). Conclusions: This meta-analysis shows no difference in stone-free and complication rates or hospital stay if PCNL is done under GA or LA/RA. LA/RA offers advantages for better intraoperative hemodynamic stability with lesser post-operative nausea and vomiting. PCNL under RA adoption in clinical practice is perhaps limited to centers where specialist anesthetist services can support this procedure.