• World Neurosurg · Jan 2022

    Multicenter Study Comparative Study

    Chronic subdural hematoma drainage under local anesthesia with sedation versus general anesthesia and its outcome.

    • Hui Mei Wong, Xiang Ling Woo, Chin Hwee Goh, CheePeter Hui ChangPHCDepartment of Anesthesia, Timberland Medical Center, Sarawak, Malaysia., Aishah Haji Adenan, TanPeter Chee SeongPCSDepartment of Anesthesia, Sarawak General Hospital, Jalan Hospital, Sarawak, Malaysia., and WongAlbert Sii HiengASHDepartment of Neurosurgery, Sarawak General Hospital, Jalan Hospital, Sarawak, Malaysia; Department of Neurosurgery, Timberland Medical Center, Sarawak, Malaysia. Electronic address: wonghm96@yahoo.com..
    • University College London Medical School, London, United Kingdom.
    • World Neurosurg. 2022 Jan 1; 157: e276-e285.

    BackgroundBurr hole drainage is the criterion standard treatment for chronic subdural hematoma (CSDH), a common neurosurgical condition. However, apart from the surgical technique, the method of anesthesia also has a significant impact on postoperative patient outcome. Currently, there are limited studies comparing the use of local anesthesia with sedation (LA sedation) versus general anesthesia (GA) in the drainage of CSDH. The objective of this study was to compare the morbidity and mortality outcomes of using LA sedation versus GA in CSDH burr hole drainage.MethodsThis retrospective study presents a total of 257 operations in 243 patients from 2 hospitals. A total of 130 cases were operated under LA sedation in hospital 1 and 127 cases under GA in hospital 2. Patient demographics and presenting features were similar at baseline.ResultsValues are shown as LA sedation versus GA. Postoperatively, most patients recovered well in both groups with Glasgow Outcome Scale scores of 4-5 (96.2% vs. 88.2%, respectively). The postoperative morbidity was significantly increased by an odds ratio of 5.44 in the GA group compared with the LA sedation group (P = 0.005). The mortality was also significantly higher in the GA group (n = 5, 3.9%) than the LA sedation group (n = 0, 0.0%; P = 0.028). The CSDH recurrence rate was 4.6% in the LA sedation group versus 6.3% in the GA group. No intraoperative conversion from LA sedation to GA was reported.ConclusionsThis study demonstrates that CSDH drainage under LA sedation is safe and efficacious, with a significantly lower risk of postoperative mortality and morbidity when compared with GA.Copyright © 2021 Elsevier Inc. All rights reserved.

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