252 Chronic Subdural Hematoma Drainage Under Local Versus General Anesthesia: Systematic Review and Meta-analysis

Abstract

INTRODUCTION: Chronic subdural hematoma (CSDH) is one of the most encountered conditions seen in neurosurgery. Although mainstay treatment of cSDH has been burr hole drainage, no consensus yet exists on optimal anesthetic technique for surgical treatment between general (GA) and local (LA) anesthesia. METHODS: A search was conducted in MEDLINE (1946 to November 11, 2022), Embase (1974 to November 11, 2022), and PubMed (up to November 11, 2022). We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to systematically screen studies. RESULTS: Our literature search identified 521 studies, out of which 20 were included. There were a total of 1750 patients in the LA group and 699 patients in the GA group. Our meta-analysis found that the LA group had significant shorter operative time (mean difference -29.28 minutes, p <0.0001), length of admission (Mean difference -1.58 days, 95% CI = -2.40 to -0.76 days, p = 0.0002), and postoperative complications rate (odds ratio 0.38, 95% CI = 0.25 to 0.59, p < 0.0001) compared to GA. There was no significant difference between the two groups in revision rate (odds ratio 2.71, 95% CI 0.89 to 8.25, p = 0.08) and mortality rate (odds ratio 1.23, 95% CI 0.63 to 2.43, p = 0.55). CONCLUSIONS: In this meta-analysis, LA shows benefits in shorter operative time, shorter admission length, and fewer postoperative complications. This makes local anesthesia a less invasive alternative to general anesthesia especially in elderly patients.