General versus spinal anesthesia in percutaneous nephrolithotomy: A systematic review and meta-analysis

Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for removal of large kidney stones, sized >20 mm. However, there still an ongoing debate concerning best anesthesia PCNL. This study aimed to compare efficacy and safety between general spinal PCNL. Methods: A systematic review meta-analysis study. A systematic, electronic literature search was performed in several databases, including PubMed, Scopus, Google Scholar until July 1st, 2022. The quality articles examined using Crombie's Items (for non-randomized controlled trials (RCTs)) Jadad Scale RCTs). outcomes assessed were operation time, fluoroscopy length stay, stone-free rate, overall complication specific postoperative complications, cost, pain score, analgesic requirement. The article selection reported based on Preferred Reporting Systematic Reviews Meta-Analysis (PRISMA) guidelines. We four RCTs eight retrospective studies. Meta-analysis selected studies Review Manager 5.3. Results: General resulted fewer Clavien–Dindo grade II (OR: 0.68; 95% CI: 0.49 – 0.94; p=0.02), major complications 0.65; 0.45 p=0.02, lower transfusion rates 0.70; 0.53 p=0.02). Whereas faster time (Mean Difference: -12.98; -20.56 -5.41; p<0.001, (MD: -26.15; -42.79 -9.50; p=0.002), reduced stay -0.47; -0.75 0.20; p<0.001), requirement cost. No significant difference rate 1.08; 0.92 1.26; p=0.37). PCNL either or equally safe effective. Conclusions: Each method has its own advantages disadvantages. final choice should be patient's condition surgical team preference.