BACKGROUND We analyzed the influence of anesthesia methods on surgical outcomes and renal function in retrograde intrarenal surgery (RIRS) in a prospective, randomized controlled study. METHODS Seventy patients who underwent RIRS from September 2015 to February 2017 were randomly allocated to general anesthesia (GA) or spinal anesthesia (SA) groups. Renal function was assessed using estimated glomerular filtration rate, and separate renal function was evaluated using nuclear medicine tests. Maneuverability and accessibility were evaluated after every surgery. All procedures were performed by a single experienced surgeon (SY Cho). RESULTS Stone-free rate was higher in the GA (92.3%, 36 of 39) than the SA (71.0%, 22 of 31) (P = 0.019) group. Pain score was higher in the GA than in the SA group on the first postoperative morning (P = 0.025), but pain scores of the two groups were similar before discharge (P = 0.560). There were no differences in the changes of serum creatinine level (P = 0.792) and changes of estimated glomerular filtration rate (P = 0.807). Differences of separate renal function between operative and contralateral site increased significantly in patients under GA than under SA at postoperative 3 months (P = 0.014). Maneuverability and accessibility were better in SA with sedation than GA (P < 0.001). CONCLUSIONS RIRS under SA showed advantages in renal function change using renogram at postoperative 3 months and in lower pain score on the first postoperative morning. Performance of operator under SA was worse than that under GA and significantly improved with sedation. RIRS under SA showed advantages in lower pain score at postoperative first day. TRIAL REGISTRATION Clinicaltrials.gov ID is NCT03957109, and registration date is 17th May 2019. This study was retrospectively registered.

中文翻译：

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麻醉方法对逆行肾内结石手术的手术效果和肾功能的影响：一项前瞻性，随机对照研究。

背景我们在一项前瞻性，随机对照研究中分析了麻醉方法对肾内逆行手术（RIRS）中手术结局和肾功能的影响。方法将2015年9月至2017年2月接受RIRS的70例患者随机分为全身麻醉（GA）或脊柱麻醉（SA）组。使用估计的肾小球滤过率评估肾功能，并使用核医学测试评估单独的肾功能。每次手术后都要评估可操作性和可及性。所有程序均由一位经验丰富的外科医生（SY Cho）执行。结果GA组的无结石率更高（92.3％，第36个，共39个），高于SA组（71.0％，第22个，共31个）（P = 0.019）。术后第一个早晨，GA组的疼痛评分高于SA组（P = 0.025），但两组出院前的疼痛评分相似（P = 0.560）。血清肌酐水平的变化（P = 0.792）和估计的肾小球滤过率的变化（P = 0.807）没有差异。术后3个月，接受GA的患者与接受SA的患者相比，手术和对侧部位的独立肾功能差异显着增加（P = 0.014）。具有镇静作用的SA的可操作性和可及性比GA更好（P <0.001）。结论SA下RIRS在术后3个月使用肾图检查显示肾功能改变方面具有优势，并且在术后第一天早晨具有较低的疼痛评分。SA的操作者的表现比GA的要差，并且镇静效果显着改善。SA下的RIRS在术后第一天显示出较低的疼痛评分优势。