The Use of Spinal Anaesthesia for Retrograde Uretero-Renoscopy during the COVID-19 Pandemic

Abstract

Background
The use of spinal anaesthesia (SA) for retrograde uretero-renoscopic surgery is considered to be not as effective as a general anaesthetic (GA) by urologists. However, there were significant concerns associated with GA both for the patient and the anaesthetic team at the height of the COVID-19 pandemic. Our unit was able to successfully transfer surgery to a purpose-built day facility that had extensive experience in delivering SA. This created the opportunity to assess the SA technique in uretero-renoscopy in a cohort of unselected patients.

Objective
To assess the feasibility of SA as a primary form of anaesthetic for retrograde endoluminal renal and ure-teric surgery.

Results
Over 4 months, 41 ureteroscopic procedures were performed. The conversion rate to GA (for inadequate analgesia) was 9.8%. Surgical outcome data were compared with an equivalent cohort of patients’ who underwent GA before the pandemic. Both groups had similar outcomes: day-case discharge rate (SA 84%, GA 86%) and surgical completion rate (SA 94%, GA 90%). However, there was a difference in post-operative readmission rate (SA 8%, GA 22%) favouring SA.

Conclusions
This observational study demonstrated that SA is a safe and effective form of anaesthesia for uretero-renoscopic surgery, delivering non-inferior outcomes to GA. This has implications for the immediate provision of care as COVID-19 continues and as an alternative anaesthetic option to suit patients post pandemic. A larger pro-spective observational study would be appropriate to clearly define the benefits of SA for ureteroscopy.