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A recent review found loco-sedative anesthesia to be a promising technique for various urologic interventions, supporting procedures safely and effectively.

General or spinal anesthesia is the standard for many urologic procedures. Yet it entails significant drawbacks: confinement to operating theaters, elevated personnel and facility costs, extended patient wait times, and growing surgical backlogs. Procedures ranging from transurethral resection of the prostate to complex reconstructive surgeries typically depend on deep anesthesia, which restricts settings to fully equipped ORs and incurs substantial overhead. As healthcare systems strive to optimize efficiency without compromising quality, alternatives to conventional anesthetic regimens have garnered attention.

In a recent literature review published in Urology, corresponding author Premal Patel, MD, University of Manitoba, and colleagues examined one such alternative: Loco-sedative anesthesia. The review encompassed over 20 clinical trials and retrospective analyses spanning 2 decades.

Loco-Sedative Anesthesia Offers Many Advantages

“The study demonstrates that local anesthesia alone or in combination with conscious sedation can be effectively and safely used for various urologic procedures without compromising surgical outcomes or patient comfort,” Dr. Patel stated.

Among the reviewed studies, loco-sedative anesthesia matched or exceeded traditional methods across four key metrics: operative time, intraoperative vital signs, symptoms, and postoperative pain. Success rates ranged from 83% to 100%, underscoring its clinical viability.

The findings suggested that adopting loco-sedative anesthesia could significantly reduce operating room dependence and shorten patient wait times. Additionally, freed from the need for general or spinal protocols, clinicians may achieve greater procedural throughput and alleviate resource bottlenecks, according to the authors.

Procedure-Specific Findings

• Cystoscopy/Vesicular Interventions
  • The vast majority could be performed with local anesthesia.
  • 90% of patients expressed a preference for local anesthesia.
  • Individuals younger than 60 years—and women particularly—benefited from local anesthesia.
• Ureteric/Urethral Interventions
  • Limited studies suggest safety for double-J stent placement and percutaneous nephrostomy tube insertion.
  • Patient engagement, such as observing the procedure or listening to music, reduced perceived pain.
  • Topical xylocaine jelly and NSAIDs further enhanced comfort.
• Penile-Scrotal Interventions
  • Needle-free jet injection of anesthetic reduced administration discomfort.
  • Local anesthesia decreased clamp-ablation time and related complications.
  • Several reports indicated lower postoperative pain scores with loco-sedative techniques.

Implementation Considerations

Despite its promise, the evidence base is limited by variable study quality and potential staffing challenges associated with non-traditional anesthesia techniques. For clinicians interested in this strategy, Dr. Patel advised: “Start with a stepwise implementation, initially performing these procedures in a setting where conversion to deep anesthesia is possible if necessary.” He also advised collaborating closely with colleagues experienced in loco-sedative methods to ensure patient safety and smooth integration.

Nonetheless, the authors concluded, “Given the high efficacy rates, loco-sedative anesthesia is a promising technique for urologic interventions and should be further investigated to determine whether it may become the standard of care.”