Artikel
Patient perception and satisfaction in awake burr hole trepanation under local anesthesia for evacuation of chronic subdural haematoma
Patientenwahrnehmung und -zufriedenheit bei einer Bohrlochtrepanation in Lokalanästhesie im Wachzustand zur Entlastung eines chronischen subduralen Hämatoms
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Veröffentlicht: | 25. Mai 2022 |
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Objective: Evacuation of chronic subdural hematoma (CSDH) will be one of the most common neurosurgical procedures in the future in the increasingly aging Western society and is routinely performed on awake patients. To some this may place a psychological burden. Aim of this study was to explore the psychological distress of patients during CSDH relief.
Methods: Patients with awake evacuation of CSDH were enrolled in our monocenter prospective study, with unimpaired consciousness and ability to self-report as the main selection criteria. Clinical and surgery-specific data, like surgeon´s level of training, were collected. In addition, patient satisfaction was measured using standardized questionnaires 3–5 days and 6 months after surgery. Perceived pain was reported using the numerical rating scale (NRS).
Results: A total of 49 patients were included (30 male and 19 female). The mean age was 73 years (range 51– 92). Before surgery, 21 patients reported pain (mean score 3.8 on the NRS), 18 patients reported sleep disturbances and 21 concentration disturbances. During the operation, 27 patients reported pain (mean 3.9 on the NRS) and 17 patients had intraoperative anxiety (mean 2.6). Postoperatively, 27 patients experienced pain (mean 2.7). 12 patients reported postoperative sleep disturbances and 13 concentration disorders. On a scale of 0–10, patients reported their satisfaction with surgery with a mean score of 8.7 (range 5–10). In the days following surgery, 73% patients would agree to another operation. Agreement increased to 80% in the survey 6 months after the procedure. Duration of surgery differed significantly with respect to surgeon's level of training. Surgeries performed by the chief physician or senior physicians took a mean of 29.3±10.7 min, while residents' procedures took 45.2±27.1 min (p=0.015). Intraoperatively perceived pain also varied significantly with level of training (median 0 for chief physician; median 4 and 5 for resident and senior physicians, respectively (p=0.019)). At 6-month follow-up, there was no significant difference in retrospective patient satisfaction depending on surgeon's level of training (p=0.35). We observed no adverse events during awake burr hole trepanation and switching to general anesthesia was not necessary in any case.
Conclusion: Burr hole evacuation of CSDH under local anesthesia in awake patients is a favorably perceived procedure to avoid general anesthesia, especially in view of the older age of the patients.