Safety and efficacy of sonography-guided PCNL under local versus general or spinal-epidural anesthesia: A meta-analysis.

Background: To conduct a comprehensive meta-analysis of existing evidence to compare the safety and efficacy of sonography-guided percutaneous nephrolithotomy (PCNL) under local infiltration anesthesia and both general anesthesia (GA) and combined spinal-epidural anesthesia for upper urinary calculi.

Methods: We conducted a systematic literature search in the EMBASE, MEDLINE, Cochrane databases, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Google Scholar to identify relevant studies published in English or Chinese up to March 2024. Literature reviewed included randomized and nonrandomized studies. The subject in the management of PCNL under local and GA of studies being patients who had a disease of upper urinary calculi were selected. The odds ratio and mean difference with 95% confidence intervals (CI) were calculated using fixed- or random-effects models. Two reviewers independently assessed the quality of all included studies, and the RevMan 5.3 and Stata 12.0 software was used to analyze the included studies.

Results: Seven studies with 899 patients showed that, comparing with PCNL under GA or combined spinal-epidural anesthesia, PCNL under local infiltration anesthesia offered a significantly shorter operative time (MD = -18.91, 95% CI: -26.47 to -11.35, P < .00001, I2 = 96%), lower hospitalization expenses (MD = -4097.43,95% CI: -4203.26 to 3991.59, P < .00001, I2 = 0%), lower complication rate (OR = 0.49, 95% CI: 0.33-0.73, P = .0005, I2 = 0%), shorter postoperative hospital stay (MD = -1.85, 95% CI: -2.47 to 1.24, P = .001, I2 = 85%). But no statistical significant difference was found in stone-free rate between PCNL under local infiltration anesthesia and GA or combined spinal-epidural anesthesia (OR = 1.67, 95% CI: 0.54-5.15, P = .37, I2 = 41%).

Conclusion: This meta-analysis compared efficacy and safety of PCNL under local infiltration anesthesia and both GA and combined spinal-epidural anesthesia for upper urinary calculi. Both of them were safe and effective for patients of upper urinary calculi. PCNL under local anesthesia offered a shorter operative time, lower hospitalization expenses, lower complication rate and shorter postoperative hospital stay for upper urinary calculi.