Prospective study of the efficacy of PCNL under local anesthesia based on the ERAS concept

Zhaorong Liu^1*Longfei Yang¹Jian Biao Jian Huang²Dingyi Zhang²Yugen Li¹Xiaoning Wang¹Fengzhen Luo^3*Zhihua He^1*

• ¹First Affiliated Hospital of Gannan Medical University, Ganzhou, China
• ²Department of Laboratory Medicine, Jiangxi Cancer Hospital, Nanchang, Jiangxi Province, China
• ³Yudu County Second People's Hospital, Ganzhou, Jiangxi Province, China

Objective: To evaluate the feasibility, safety, and efficacy of local anesthesia applied to percutaneous nephrolithotomy (PCNL) under Enhanced Recovery After Surgery (ERAS) for treating upper urinary tract stones.This study was a prospective, single-center randomized controlled study in which the patients were randomly divided into two groups: 40 in the ERAS PCNL under local anesthesia (ERAS-LA) group and 40 in the ERAS PCNL under general anesthesia (ERAS-GA) group). The primary indicators were stone-free rate; the secondary outcomes were intraoperative and postoperative complications, intraoperative and postoperative VAS pain scores and postoperative stress response indicators. A meta-analysis was also performed using RevMan 5.4 software by searching relevant literatures in PubMed/Medline, Web of Science and Embase.Results: The stone clearance rates at 48 h were similar between the two groups (ERAS-LA: 85.0% (34/40) vs ERAS-GA: 87.5% (35/40), P=0.800) and both 90% at one month.The incidence of surgical complications was similar between the two group. The intraoperative pain score in ERAS-LA group was 2.90±0.74, and the postoperative 24-h pain score was comparable between the two groups (ERAS-LA: 2.65±1.35 vs ERAS-GA: 2.63±0.98, P=0.925), with good pain control. The mean total operative time was lower in ERAS-LA group than in ERAS-GA group (68.15±24.11 min vs 82.125±20.42 min, P=0.006). Postoperative hemoglobin change values (3.38±3.00*10 9 /L vs 5.22±4.18*10 9 /L, P=0.027) and stress response factors including C-reactive protein (8.39±7.46 mg/L vs 10.47±10.30 mg/L, P=0.035) and interleukin-6 (5.40±1.50 pg/ml vs 10.57±1.82 pg/ml, P=0.041) were significantly lower in ERAS-LA group. The mean catheter retention, fistula retention, and postoperative hospital stay were all significantly lower in ERSA-LA group than in ERSA-GA group (2.3%, 2.9%, and 5.08 days vs. 3.33%, 4.38%, and 6.35 days, P < 0.05). The results of the meta-analysis were similar to that of our study.Local anesthesia applied to ERAS-managed PCNL have a comparable stone clearance rates and complication rates, and a faster postoperative recovery, lower surgical stress, length of stay, anesthesia costs and hospital costs than general anesthesia.