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Chronic Subdural Hematoma Drainage under Local versus General Anesthesia: Systematic Review and Meta-Analysis

Eva Liu1, Amy Zhou1, Natalie Tilbury1

  • 1Department of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

World Neurosurgery
|January 20, 2024
PubMed

Insights

Local anesthesia (LA) for chronic subdural hematoma evacuation offers shorter operative times, reduced hospital stays, and fewer complications compared to general anesthesia (GA). This makes LA a favorable, less invasive option, particularly for elderly patients undergoing neurosurgery.

Area of Science:

  • Neurosurgery
  • Anesthesiology
  • Evidence-based medicine

Background:

  • Chronic subdural hematoma (CSDH) is a common neurosurgical condition requiring treatment, typically burr-hole drainage.
  • Optimal anesthetic strategy for CSDH evacuation remains debated between general anesthesia (GA) and local anesthesia (LA).
  • This systematic review and meta-analysis compare postoperative outcomes of CSDH evacuation under LA versus GA.

Approach:

  • Systematic literature search conducted in MEDLINE, Embase, and PubMed up to November 2023.
  • Included 12 studies with 1035 patients in the LA group and 699 patients in the GA group.
  • Followed PRISMA guidelines for study screening and data synthesis.

Key Points:

  • Local anesthesia (LA) group demonstrated significantly shorter operative times (mean difference: -29.28 minutes).
  • LA group experienced significantly shorter length of admission (mean difference: -1.58 days).
  • LA group showed a significantly lower rate of postoperative complications (OR: 0.38).
  • No significant differences were observed in revision rates (OR: 0.77) or mortality (OR: 1.23) between LA and GA groups.

Conclusions:

  • Local anesthesia (LA) offers significant advantages over general anesthesia (GA) for chronic subdural hematoma evacuation.
  • Benefits include reduced operative time, shorter hospital stays, and fewer postoperative complications.
  • LA presents a less invasive and potentially superior anesthetic alternative, especially for elderly patient populations.
Abstract

Keywords:
General anesthesiaLocal anesthesiaSDHSubdural hematomaSystematic review

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