Retrograde intrarenal surgery (RIRS) is one of the most common surgical procedures for treatment of upper urinary tract stones. For the majority of RIRS cases, general anesthesia (GA) is the traditional anesthetic technique used to prevent aspiration and respiratory embarrassment. Potential side-effects of the drugs administered in GA, safety, relatively longer hospital stay and cost, all are limitations addressed for GA. Recently, spinal anesthesia (SA) has been documented to be equally favorable in many hospital settings. To the best of our knowledge, no studies have been done comparing the outcomes of SA and GA in patients underwent RIRS. Therefore, a double-blinded randomized controlled study was performed to compare intra-operative and early post-operative outcomes in two groups of patients submitted to retrograde intra-renal surgery (RIRS) using spinal or general anesthesia.
A total of sixty-eight patients who met the inclusion criteria for RIRS were consecutively randomized using the sealed envelope technique to receive either general anesthesia (Group I) or spinal anesthesia (Group II). In addition to baseline demography, intra-operative data including operative time, laser emission duration, power and complications were evaluated and recorded. Both groups were assessed for postoperative stone clearance, pain using visual analogue scale of pain, analgesic use and length of hospital stay. Hospital ethics approval was obtained and all patients provided written informed consent before being enrolled into the study.
A total of 64 patients randomized to Group I (n = 31) and Group II (n = 33) completed the study. In spinal anesthesia group, all procedures were completed with no anesthetic conversion. Demographic and pre-operative characteristics were comparable across both study groups (p> 0.05). Intraoperative data including stone burden, operative time, Hounsfield unit (HU), laser power and duration had no statistical difference between groups (p = 0.853, 0.118, 0.956, 0.194, 0.067), respectively. Although, urinary access sheath was significantly used for longer duration in spinal anesthesia group (p = 0.045), yet this had no significant impact on intra-operative course, complications and post-operative outcome (p > 0.05). Concerning maneuverability, visibility and pain, there was no statistical difference in mean scores between the two groups (p = 0.223, 0.277, 0.283). The mean total hospital stay was significantly shorter in spinal group compared to general one (9.4 vs. 12.3 hours, respectively; p < 0.001).
The study demonstrated that RIRS is safe and feasible under spinal anesthesia with shorter hospital stay and less cost burden in hospital setups particularly in developing countries.