Ureteroscopic lithotripsy combined with paravertebral block anesthesia or general anesthesia: A propensity matched case-control study.

Abstract

BACKGROUND\nTo evaluate the safety, efficacy and cost of paravertebral block anesthesia for ureteral stones patients undergoing ureteroscopic lithotripsy.\n\n\nMETHODS\nFour hundred and eighty-two patients who underwent ureteroscopy for unilateral ureteral stones were incorporated into our retrospective study. A propensity-matched comparison in patients with paravertebral nerve block anesthesia (PVB) group and general anesthesia (GA) group was performed. Intraoperative hemodynamic parameters, operative time, visual analog scale for pain, stone-free rate, anesthetic cost and postoperative hospital stay were compared between the two groups.\n\n\nRESULTS\nSixty-one GA cases were propensity matched to 61 PVB cases. In the PVB group, all the procedures were completed successfully without anesthesia conversion. Significantly less intraoperative severe hypotensive (P\xa0=\xa00.002) and arrhythmia (P\xa0<\xa00.001) episodes in PVB group. There were no significant differences in operative time (p\xa0=\xa00.702), initial stone-free rate (p\xa0=\xa00.686), and total stone-free rate (p\xa0=\xa00.794) between the two groups. The PVB group had lower postoperative pain and prolonged analgesia (p\xa0=\xa00.007). The postoperative hospital stay in the PVB group was significantly shorter (3.20\xa0±\xa00.73 vs 3.84\xa0±\xa01.32\xa0d, p\xa0=\xa00.001). And the cost of anesthesia was lower in the PVB group (195.47\xa0±\xa013.01 vs 396.31\xa0±\xa036.45 US dollars, p\xa0<\xa00.001).\n\n\nCONCLUSION\nUnder PVB anesthesia, URS can be successfully completed without anesthetic transformation, and its efficacy and safety have been demonstrated. When economic aspects are taken into consideration, PVB seems to be a more economical and effective anesthetic method of URS.