Clinical and radiological outcome of hydrogen peroxide hemostasis in evacuation of brain contusion and intracerebral hemorrhage: A prospective study

Objectives: To determine the association of clinical and radiological outcomes of using hydrogen peroxide (H₂O₂) irrigation as hemostatic agent during evacuation of traumatic contusion and intracerebral hemorrhage. Methodology: A prospective observational cohort study of 181 patients who underwent evacuation surgery for contusion or intracerebral hemorrhage with H₂O₂ irrigation during the procedure at Department of Neurosurgery, Unit-I, Punjab Institute of Neurosciences, Lahore, Pakistan from May 2026 to August 2026. The clinical and radiological outcomes of intraoperative utilization of H₂O₂ were assessed using Mann–Whitney U and Spearman’s correlation tests and multivariable linear regression analysis with a p value of < 0.05 deemed significant. Results: Of the 181 patients were included in the study, there were 77.9% (141) male patients and 22.1% (40) female patients with the mean age of patients was 41.4 ± 16.1 years. The most common intraoperative complaint was reported hypotension in 9.4% (17) patients followed by arrhythmia in 2.8% (5) patients and bradycardia in 4.4% (8) patients. Intraoperatively, patients who experienced intraoperative hypotension, postoperative new-onset sensory deficit, residual hematoma, new ischemic change and pneumocephalus had higher mean ranks of volume of H₂O₂ used during surgery (p<0.05). The multiple linear regression analysis also revealed an overall significant inverse association with postoperative Glasgow Coma Scale (GCS) after adjustment for age, preoperative GCS, lobe involved, midline shift, history of coagulopathy or use of anticoagulants, diabetes, hypertension and type of surgery (B = −0.053, 95% CI: -0.105-0.000, p = 049). Conclusion: Intraoperative hypotension, postoperative GCS, emergence of new onset sensory deficits and occurrence of postoperative new onset ischemic changes, residual hematoma or pneumocephalus on CT scan is associated with volume of H₂O₂ used during surgery.