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Meta-Analysis
. 2024 Apr 16;47(1):162.
doi: 10.1007/s10143-024-02420-1.

Local anesthesia with sedation and general anesthesia for the treatment of chronic subdural hematoma: a systematic review and meta-analysis

Mariam Ahmed Abdelhady #  1   2 , Ahmed Aljabali #  3 , Mohammad Al-Jafari #  4 , Ibrahim Serag  5 , Amr Elrosasy  6 , Ahmed Atia  6 , Aya Ehab  7 , Shrouk F Mohammed  8 , Ibraheem M Alkhawaldeh  4 , Mohamed Abouzid  9   10
Affiliations
Meta-Analysis

Local anesthesia with sedation and general anesthesia for the treatment of chronic subdural hematoma: a systematic review and meta-analysis

Mariam Ahmed Abdelhady et al. Neurosurg Rev. .

Abstract

Background: Surgery is the primary treatment for chronic subdural hematoma, and anesthesia significantly impacts the surgery's outcomes. A previous systematic review compared general anesthesia to local anesthesia in 319 patients. Our study builds upon this research, analyzing 4,367 cases to provide updated and rigorous evidence.

Methods: We systematically searched five electronic databases: PubMed, Cochrane Library, Scopus, Ovid Medline, and Web of Science, to identify eligible comparative studies. All studies published until September 2023 were included in our analysis. We compared six primary outcomes between the two groups using Review Manager Software.

Results: Eighteen studies involving a total of 4,367 participants were included in the meta-analysis. The analysis revealed no significant difference between the two techniques in terms of 'recurrence rate' (OR = 0.95, 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), and 'reoperation rate' (OR = 0.95, 95% CI [0.5 to 1.79], P = 0.87). Local anesthesia demonstrated superiority with a lower 'complications rate' than general anesthesia, as the latter had almost 2.4 times higher odds of experiencing complications (OR = 2.4, 95% CI [1.81 to 3.17], P < 0.00001). Additionally, local anesthesia was associated with a shorter 'length of hospital stay' (SMD = 1.19, 95% CI [1.06 to 1.32], P < 0.00001) and a reduced 'duration of surgery' (SMD = 0.94, 95% CI [0.67 to 1.2], P < 0.00001).

Conclusion: Surgery for chronic subdural hematoma under local anesthesia results in fewer complications, a shorter length of hospital stay, and a shorter duration of the operation.

Keywords: Chronic subdural hematoma; General anesthesia; Local anesthesia; Sedation; Systematic review.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Description of the study selection process in coherence with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines
Fig. 2
Fig. 2
(a) Risk of bias domains; (b) Summary of the plot for the included RCTs
Fig. 3
Fig. 3
A funnel plot was used to assess publication bias in studies reporting (a) recurrence; (b) complications; (c) reoperation; (d) length of hospital stay; and (e) length of operation
Fig. 4
Fig. 4
A Forest plot analyzing postoperative (a) recurrence; (b) complications; (c) mortality and (d) reoperation after GA and LA. Additionally, it examines the effects of GA and LA on the length of (e) hospital stay; and (f) operation
See this image and copyright information in PMC

References

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