Local Anesthesia with Sedation and General Anesthesia for the Treatment of Chronic Subdural Hematoma: A Systematic Review and Meta-analysis
Mariam Abdelhady1, Ibrahim Serag2, Ibraheem Alkhawaldeh3, Ahmed Aljabali4, Mohammad Al-Jafari5, Amr Elrosasy6, Aya Ehab7, Ahmed Atia6, Shrouk Fawze Mohammed8, Mohamed Abouzid9, Ahmed Negida10
1Faculty of Medicine, October 6 University, 2Faculty of medicine mansoura University, 3Faculty of Medicine, Mutah University, 4Faculty of Medicine, Jordan University of Science and Technology, 5Faculty of Medicine, Mutah University, Al-Karak, Jordan, 6Faculty of Medicine, Cairo University, Cairo, Egypt, 7faculty of medicine aswan university , Aswan , Egypt, 8Faculty of medicine, Alexandria university, Alexandria, Egypt, 9Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, 10Virginia Commonwealth University
Objective:
We aimed to investigate the effect of general anesthesia versus local anesthesia on the rates of recurrence and mortality, as well as the clinical outcomes of cSDH
Background:
Surgery is the main line of treatment for Chronic Subdural Hematoma (CSDH), and anesthesia has a great influence on the outcomes of the surgery. A previous systematic review compared general anesthesia (GA) to local anesthesia (LA) in a group of 319 subjects. In our study, we update the evidence with 3637 more cases and provide rigorous analysis.
Design/Methods:
We systematically searched five electronic databases: PubMed, Cochrane Library, Scopus, Ovid Medline, and Web of science for eligible comparative studies. All studies till October 2022 were included. Six primary outcomes were compared between the two groups. We used Review Manager Software.
Results:
Eighteen studies with a total of 4028 were included in the meta-analysis. There was no significant difference between the two techniques in terms of “recurrence rate” (OR= .95, 95% CI [0.78 to 1.15], P=0.59), “mortality rate” (OR= 1.02, 95% CI [0.55 to 1.88], P=0.96), “reoperation rate” (OR=0.95, 95% CI [0.5 to 1.79], P=0.87), local anesthesia was superior with lower “complications rate” (OR=2.4, 95% CI [1.81 to 3.17], P<0.00001). On the other hand, local anesthesia was superior with a shorter “length of hospital stay” (SMD =1.19, 95% CI [1.06 to 1.32], P<0.00001), and a shorter “duration of surgery” (SMD=0.94, 95% CI [0.67 to 1.2], P<0.00001).
Conclusions:
No difference was found between the two techniques in terms of recurrence, mortality, and revision rate. However, local anesthesia had fewer complications, while the length of hospital stay and operation duration was shorter in local anesthesia.