General Versus Local Anesthesia in Stapes Surgery for Otosclerosis: Systematic Review and Meta-Analysis

The aim of this study was to investigate the influence of type of anesthesia on audiometric results, surgery duration, quality-of-life and complications associated with stapes surgery in patients with otosclerosis.

A comprehensive literature search was conducted in five databases, including PubMed, Embase, SCOPUS, WoS, and Google Scholar.

We have identified studies comparing the outcomes of stapes surgery under local-anesthesia (LA) versus general-anesthesia (GA) and published up to 30 May 2025. All analyses were performed using Comprehensive-Meta-Analysis-software and Review-Manager.

Operating room occupancy was significantly lower in surgery under LA than GA (MD = -17.27 min, 95% CI [-24.72, -9.83], p < 0.001,I ² = 0%). Moreover, stapes surgery had a significantly shorter duration under LA compared to GA (MD = -8.79, 95% CI [-15.69, -1.88], p = 0.01,I ² = 0%). The meta-analysis on changes in AC, BC, SR thresholds, and ABG showed no significant difference between patients who underwent LA or GA (AC: MD = 0.704, 95% CI [-3.344, 4.752], p = 0.733; BC: MD = 0.191, 95% CI [-2.231, 2.612], p = 0.877; SR: MD = 0.103, 95% CI [-3.621, 3.827], p = 0.957; ABG: MD = 0.451, 95% CI [-0.788, 1.689], p = 0.476). The meta-analysis on ABG closure also showed no significant difference (< 10 dB: OR = 1.066, 95% CI [0.718, 1.582], p = 0.752; 10 to 20 dB: OR = 1.151, 95% CI [0.778, 1.705], p = 0.481; > 20 dB: OR = 0.833, 95% CI [0.537, 1.293], p = 0.416). Complications were the same for both types of anesthesia, but nausea and vomiting showed a marginally significant difference between LA and GA (OR = 2.578, 95% CI [0.988, 6.732], p = 0.053, I ² = 0%).

Stapes surgery under LA is associated with shorter surgical and operating room times while demonstrating non-inferior audiometric and safety outcomes compared to GA. These findings suggest that LA represents a safe and efficient alternative to GA for stapesplasty procedures.

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