Using Local Anesthesia for Burr Hole Surgery of Chronic Subdural Hematoma Reduces Postoperative Complications, Length of Stay, and Hospitalization Cost: A Retrospective Cohort Study From a Single Center

Abstract

PurposeThe purpose of the current study was to compare the effects of local anesthesia (LA) and general anesthesia (GA) on the surgical process and postoperative recovery of patients with unilateral chronic subdural hematoma (CSDH).Patients and MethodsA retrospective cohort study was conducted on patients with unilateral CSDH who underwent burr hole surgery between the years 2013 and 2018. Patients who received local anesthesia were allocated to the LA group, and the patients who received general anesthesia were allocated to the GA group. The clinical data, postoperative complication, length of stay, and hospitalization cost of these two groups were compared and analyzed.ResultsData from 105 patients was collected for this study. Fifty one patients were assigned to the LA group and 54 to GA group. The duration of anesthesia and operation of the LA group was 37.71 (10.55) min; while for the GA group the duration was 56.04 (8.37) min (p < 0.001). The time from operation to discharge in GA group was greatly longer than that in LA group [(8.51 (1.49) days vs. 10.46 (2.34) days, respectively; p < 0.001]. Hospitalization cost for LA group was 2,721.54 (504.66) USD, which was significantly lesser than that for GA patients [3,314.82 (493.52) USD; p < 0.001]. The total number of complications in LA patients was less than that in GA patients [6 vs. 29 cases, respectively; p < 0.001]. The number of patients with residual hematoma in the LA group was <that in the GA group (p = 0.014).ConclusionAs compared to GA, LA might be a simpler, safer, and more effective method for burr hole surgery of CSDH to promote patients' recovery. However, further research is still required to confirm this conclusion.

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

“…Hence, we noticed that GA length of operation was higher than LA by 19 h (95% CI [15.77, 22.68], P < 0.00001). Therefore, LA was associated with a significantly lesser duration of hospital stay than GA, which agrees with previous studies [ 12 , 16 , 33 , 37 ]. This is a potential advantage of utilizing LA in the surgical management of CSDH.…”

Surgical techniques for evacuation of chronic subdural hematoma: a mini-review

“…Additionally, a retrospective study by Bartley et al found that irrigating the solution at body temperature results in lower recurrence rates than at room temperature (48). BHC is most commonly performed under general anesthesia, though local anesthesia is a feasible alternative, with one recent study finding local anesthesia evacuation to result in significantly lower complication rates compared to BHC evacuations performed under general anesthesia (49,50). Similar to twist drill craniostomies, this technique is preferred in the elderly population, where the increased trauma associated with craniotomy has deleterious effects (51-53).…”

High-speed drill craniostomy as a minimally invasive method of chronic subdural hematoma management. Preliminary results of a pilot study

“…Being less invasive than a classic craniotomy, the latter two methods are frequently utilized for the initial cSDH evacuation in selected patients 11,12 . Additionally, high-speed drill craniostomy is usually performed with local anesthesia, which is a simpler and safer method promoting better patient recovery 13 and reducing operative time and hospital stay 14 .…”