Need for a definitive trial of local versus general anaesthesia in chronic subdural haematoma; lessons from a systematic review, survey, and scoping review of other surgical conditions

  1. Daniel J. Stubbs
  2. Conor S. Gillespie
  3. Matthew L. Watson
  4. Basil Nourallah
  5. Caroline M Phillips
  6. George Gathercole
  7. Jamie Brannigan
  8. Keng Siang Lee
  9. Orla Mantle
  10. Vian Omar
  11. Adele Mazzoleni
  12. Githmi Palahepitiya Gamage
  13. Alvaro Yanez Touzet
  14. Munashe Veremu
  15. Youssef Chedid
  16. William H Cook
  17. Karanjit Loyal
  18. Gideon Adegboyega
  19. Oliver D Mowforth
  20. Edward Goacher
  21. Apoorva Singh
  22. Jonathan P. Coles
  23. Alexis Joannides
  24. Angelos Kolias
  25. Judith Dinsmore
  26. Iain Moppett
  27. Michael Nathanson
  28. Sally R Wilson
  29. Amit Deshmukh
  30. Edoardo Viaroli
  31. David K. Menon
  32. Ellie Edlmann
  33. Benjamin M. Davies
  34. Peter J Hutchinson
  35. Improving Care In Elderly Neurosurgery Initiative (ICENI) Working Group
0 evaluations Published on
Read the full article Related papers
This article on Sciety

Abstract

Background

Chronic subdural haematoma (cSDH) is a common neurosurgical condition, many patients have significant comorbidity or are living with frailty. Surgery is effective and can be performed under local anaesthesia (with or without sedation) or general anaesthesia. Optimal technique for both GA and LA is poorly defined but similar questions have been explored in other surgical settings. We sought to clarify the breadth of evidence for anaesthetic technique in cSDH surgery, while drawing on relevant literature from other disciplines to understand how a definitive trial of this question could be performed.

Materials and Methods

We used a combination of systematic and narrative literature search, review of trial registries, the Cochrane database, and a survey of anaesthetic and neurosurgical practitioners. An updated systematic review and meta-analysis of trial and observational studies in this area was performed following PROSPERO registration.

Results

We identified a paucity of high-quality studies, especially randomised trials, exploring this question. The literature, and a survey of anaesthetists and surgeons, suggest that local anaesthesia may bring benefits in shorter hospital stay and reduced complications. Registered studies in this field are single centre in nature while a synthesis of Cochrane reviews in other fields echoes issues of equipoise, study design, and outcome choice as key challenges in designing a definitive trial.

Conclusions

There is significant interest in this topic as evidenced by published and emerging literature and views of anaesthetists and surgeons. No registered trial is multi-centre or draws on challenges identified in similar trials from other disciplines. Our paper helps create a roadmap to a definitive trial of this crucial question.

Related articles

Related articles are currently not available for this article.