Effects of General Versus Regional Anaesthesia on Surgical Outcomes and Early Postoperative Sequelae in Minimally Invasive Surgery for Urinary Calculi: A Meta-analysis of Randomized Controlled Trials.

BACKGROUND

To systematically compare general anaesthesia (GA) and regional anaesthesia in patient undergoing minimally invasive surgery for urinary calculi, focusing on operative outcomes (e.g., operative time, length of hospital stay, stone-free rate [SFR]) and early postoperative outcomes (e.g., pain measured by the visual analog scale [VAS] and complication rate), and to provide evidence to guide anaesthetic selection.

METHODS

PubMed, Embase, and the Cochrane Library were searched from database inception to December 2025 for randomized controlled trials (RCTs) comparing GA with regional anaesthesia in minimally invasive urinary stone procedures. Study quality was assessed using the Cochrane Risk of Bias tool. Meta-analyses were conducted using RevMan 5.4. Heterogeneity was quantified using the I2 statistic; fixed-effects models were used when I2 < 50% and random-effects models when I2 ≥ 50%. Sensitivity analyses were conducted to evaluate the robustness of pooled estimates. The analysis included seven RCTs (525 participants) with regional anaesthesia administered to n = 257 and GA to n = 268.

RESULTS

Regional anaesthesia was associated with a shorter operative time compared with GA (weighted mean difference [WMD] = -8.90 minutes, 95% confidence interval [CI] = -14.53 to -3.27; p = 0.002). After excluding studies that contributed to heterogeneity, the effect remained consistent (I2= 43%; p = 0.004). No statistically significant between-group differences were observed for length of hospital stay or SFR (p > 0.05). In the primary analyses, postoperative 4-8 hours VAS scores and complication rates showed no significant differences (p > 0.05). Sensitivity analyses suggested that, after exclusion of influential studies, regional anaesthesia was associated with higher VAS scores (WMD = 1.11, 95% CI: 0.59 to 1.64; p < 0.001), and one sensitivity model suggested a higher complication rate in the regional anaesthesia group (odds ratio [OR] = 2.79, 95% CI = 1.49 to 5.20; p = 0.001). Risk-of-bias assessment varied across domains, with concerns mainly related to performance bias and incomplete reporting in some trials.

CONCLUSIONS

Regional anaesthesia may shorten overall procedure-related time in minimally invasive surgery for urinary calculi. However, its effects on postoperative pain and complications remain uncertain, and the complication outcome was sensitive to individual studies. Length of hospital stay and SFR do not appear to substantially differ between anaesthesia strategies. The PROSPERO Registration: The protocol for this meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD420261326142, https://www.crd.york.ac.uk/PROSPERO/view/CRD420261326142).