This study compare general anesthesia versus locoregional anesthesia for evacuation of chronic subdural hematoma. Half of participant will be operated under general anesthesia, while the other half will be operated under locoregional anesthesia.
General anesthesia is the most common technique for this surgery. The local anesthesia is less common but it allows to obtain the same surgical result. This last technique being more recent little study compared these two techniques in terms of complications and postoperative consequences. The investigators will randomize patients into two groups (a general anesthesia group and a locoregional anesthesia group). General anesthesia provides complete immobility and optimal surgical comfort but is a source of multiple complications, especially in a population of polypathological and polymedicated elderly patients (which is the population affected by chronic subdural hematomas). Locoregional anesthesia requires special technical training, leads to complete analgesia of the surgical procedure but does not involve complete immobility of the patient, however this technique probably leads to less postoperative complications and allows a more early rehabilitation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
60
Use of a hypnotic("propofol 2.5mg/kg"), morphine("remifentanil1yg/kg") and curare("atracurium0.5mg/kg"), with the support of orotracheal intubation and mechanical ventilation
Use of a local anesthetic(" xylocaine 1%") for the realization of scalp nerve block
Remi Hestin
Caen, Calvados, France
RECRUITINGpostoperative theoretical length of stay
Theoretical duration of postoperative hospitalization: discharge authorized after medical checklist
Time frame: 10 days
Modified Rankin score (0-6)
Measures the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability. No symptoms at all 0 (best score) No significant disability despite symptoms; able to carry out all usual duties and activities 1 Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance 2 Moderate disability; requiring some help, but able to walk without assistance 3 Moderately severe disability; unable to walk and attend to bodily needs without assistance 4 Severe disability; bedridden, incontinent and requiring constant nursing care and attention 5 Dead 6 (worst score)
Time frame: 3 month
Rates of postoperative surgical complications
acute subdural hematoma; surgical site infection; hydrocephalus
Time frame: 10 days
Postoperative medical complications rate
infectious pneumonia, urinary tract infection, phlebitis, pulmonary embolism, other
Time frame: 10 days
LIKERT scale: a measure of the degree of satisfaction of the surgeon and the patient.
A Likert scale is a psychometric scale commonly involved in research that employs questionnaires. The format of a typical five-level Likert item, for example, could be: 1. Strongly disagree (worst score) 2. Disagree 3. Neither agree nor disagree 4. Agree 5. Strongly agree (best score)
Time frame: baseline
MINI COG: Measurement of postoperative cognitive impairment at 6 months
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Two components, a 3-item recall test for memory and a simply scored clock drawing test. The test is done just before surgery, in the recovery room and the day after.
Time frame: 2 days
Mortality rate at 6 months.
Rate of patients died 6 months after the surgery
Time frame: 6 month
Simple numeric scale for postoperative pain
The Numeric Pain Rating Scale (NPRS) is a unidimensional measure of pain intensity in adults. The NPRS is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain.
Time frame: 2 days
Opioid consumption
Amount of opioids used during hospitalization
Time frame: 10 days
Admission rate in Intensive care unit
Rate of patients admitted in intensive care unit after surgery
Time frame: 3 month