Md. Amir Ali, RU Chowdhury and Abdul Hye Manik
Background: Chronic Subdural may be defined as collection of blood and blood products in between outer dura and inner arachnoid mater for more than 21 days. Most common affected population is older age group and usually by trivial head trauma. Common operative procedure is Burr hole evacuation of haematoma. Conventionally it is done by general anaesthesia. As elderly people is most affected and they obviously have some co-morbidities like HTN, Bronchial Asthma, Renal disease, CVD that may induce more operative complicacy under GA; and can be done under scalp block. Purpose of our study was to take details history, clinical examination, evaluation of hospital stay of patients underwent burr hole evacuation of chronic subdural haematoma under scalp block and GA and to choose method of anaesthesia in this regards.
Materials and Method: Our study was a randomized control, prospective variety of study. Here burr hole evacuation of CSDH under scalp block and GA, were compared to see the length of hospital stay. It was carried from March 2018 to February 2019 in Combined Military Hospital (CMH), Dhaka, Bangladesh. Total 30 cases were included in our study design and in each group 15 number of patients and all of them were above 20 years. They all were admitted and diagnosed by history, clinical examination and finally confirmed by head Computed Tomography (CT) scan. All of our patients were allocated randomly. Data of this study were collected by specially designed questionnaire and analyzed by Statistical Package for Social Sciences (SPSS) version 26.
Results: Total 30 patients were finally selected as CSDHs. They were divided in group A and group B; burr hole under scalp block & under GA respectively. Most of the patients 51-80 years age group, 24(80%) in number. Male were predominant 24(80%) and female were 6(20%) in number. In our study, it was observed that most of our patient having significant co-morbidities >83%. Patients presented to us with mostly headache 71% altered level of consciousness 23%, hemiparesis 4% & seizure 2% only. Post-op complications under scalp block only 33.33% whereas under GA were 53.33%. Hospital stay post-operatively; >1 week, under scalp block only 20% and under GA 40% patients. As most of our patients are old and having significant co-morbidities that delay post op recovery and imply complications specially under GA.
Conclusion: Burr hole evacuation is the choice of chronic subdural haematoma in most cases. But choice of anaesthesia, traditional GA or Scalp block. Scalp block has fewer complications as well as less hospital stay; as most of our patients are old and having significant co-existing diseases that delay post op recovery and induce complications under GA. So we should carefully select mode of anaesthesia during burr hole evacuation of CSDHs to reduce morbidity and expenditure as well.
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