Pain, Analgesic Use, and Patient Satisfaction With Spinal Versus General Anesthesia for Hip Fracture Surgery A Randomized Clinical Trial

被引：4

作者：

Neuman, Mark D. ^{[1
,2
]}

Feng, Rui ^{[3
,4
]}

Ellenberg, Susan S. ^{[3
,4
]}

Sieber, Frederick ^{[5
]}

Sessler, Daniel I. ^{[6
]}

Magaziner, Jay ^{[7
]}

Elkassabany, Nabil ^{[1
,2
]}

Schwenk, Eric S. ^{[8
]}

Dillane, Derek ^{[9
]}

Marcantonio, Edward R. ^{[10
]}

Menio, Diane ^{[11
]}

Ayad, Sabry ^{[6
]}

Hassan, Manal ^{[6
]}

Stone, Trevor ^{[12
]}

Papp, Steven ^{[13
]}

Donegan, Derek ^{[14
]}

Marshall, Mitchell ^{[15
]}

Jaffe, J. Douglas ^{[16
]}

Luke, Charles ^{[17
]}

Sharma, Balram ^{[18
]}

Azim, Syed ^{[19
]}

Hymes, Robert ^{[20
]}

Chin, Ki-Jinn ^{[21
]}

Sheppard, Richard ^{[22
]}

Perlman, Barry ^{[23
]}

Sappenfield, Joshua ^{[24
]}

Hauck, Ellen ^{[25
]}

Hoeft, Mark A. ^{[26
]}

Tierney, Ann ^{[4
]}

Gaskins, Lakisha J. ^{[1
,2
]}

Horan, Annamarie D. ^{[1
,27
]}

Brown, Trina ^{[4
]}

Dattilo, James ^{[4
]}

Carson, Jeffrey L. ^{[28
]}

机构：

[1] Univ Penn, Perelman Sch Med, Dept Anesthesiol & Crit Care, 308 Blockley Hall,423 Guardian Dr, Philadelphia, PA 19106 USA

[2] Univ Penn, Perelman Sch Med, Ctr Perioperat Outcomes Res & Transformat, Philadelphia, PA 19104 USA

[3] Univ Penn, Perelman Sch Med, Dept Biostat Epidemiol & Informat, Philadelphia, PA 19104 USA

[4] Univ Penn, Perelman Sch Med, Ctr Clin Epidemiol & Biostat, Philadelphia, PA 19104 USA

[5] Johns Hopkins Med Inst, Dept Anesthesiol & Crit Care Med, Baltimore, MD 21205 USA

[6] Cleveland Clin, Dept Outcomes Res, Cleveland, OH 44106 USA

[7] Univ Maryland, Sch Med, Dept Epidemiol & Publ Hlth, Baltimore, MD 21201 USA

[8] Thomas Jefferson Univ, Dept Anesthesiol, Sidney Kimmel Med Coll, Philadelphia, PA 19107 USA

[9] Univ Alberta Hosp, Dept Anesthesiol & Pain Med, Edmonton, AB, Canada

[10] Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA

[11] Ctr Advocacy Rights & Interests Elderly, Philadelphia, PA USA

[12] Univ British Columbia, Dept Orthopaed, Vancouver, BC, Canada

[13] Ottawa Hosp, Div Orthopaed, Civ Campus, Ottawa, ON, Canada

[14] Univ Penn, Dept Orthopaed Surg, Perelman Sch Med, Philadelphia, PA 19104 USA

[15] NYU Langone, Med Ctr, Dept Anesthesiol, New York, NY USA

[16] Wake Forest Sch Med, Dept Anesthesiol, Winston Salem, NC 27101 USA

[17] Univ Pittsburgh, Med Ctr, Dept Anesthesiol, Pittsburgh, PA USA

[18] Lahey Hosp & Med Ctr, Dept Anesthesiol, Burlington, MA USA

[19] SUNY Stony Brook, Dept Anesthesiol, Stony Brook, NY 11794 USA

[20] Inova Fairfax Med Campus, Dept Orthoped Surg, Falls Church, VA USA

[21] Univ Toronto, Dept Anesthesiol & Pain Med, Toronto, ON, Canada

[22] Hartford Hosp, Dept Anesthesiol, Hartford, CT 06115 USA

[23] Oregon Hlth & Sci Univ, Portland, OR 97201 USA

[24] Univ Florida, Coll Med, Dept Anesthesiol, Gainesville, FL USA

[25] Temple Univ, Dept Anesthesiol, Lewis Katz Sch Med, Philadelphia, PA 19122 USA

[26] Univ Vermont, Dept Anesthesiol, Larner Coll Med, Burlington, VT USA

[27] Univ Penn, Dept Orthopaed Surg, Perelman Sch Med, Philadelphia, PA 19104 USA

[28] Rutgers Robert Wood Johnson Med Sch, Div Gen Internal Med, New Brunswick, NJ USA

来源：

ANNALS OF INTERNAL MEDICINE | 2022年 / 175卷 / 07期

关键词：

THERAPY AMERICAN-SOCIETY; REGIONAL-ANESTHESIA; MORTALITY; MODERATE; MILD;

D O I：

暂无

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: The REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) trial found similar ambulation and survival at 60 days with spinal versus general anesthesia for hip fracture surgery. Trial outcomes evaluating pain, prescription analgesic use, and patient satisfaction have not yet been reported. Objective: To compare pain, analgesic use, and satisfaction after hip fracture surgery with spinal versus general anesthesia. Design: Preplanned secondary analysis of a pragmatic randomized trial. (ClinicalTrials.gov: NCT02507505) Setting: 46 U.S. and Canadian hospitals. Participants: Patients aged 50 years or older undergoing hip fracture surgery. Intervention: Spinal or general anesthesia. Measurements: Pain on postoperative days 1 through 3; 60-, 180-, and 365-day pain and prescription analgesic use; and satisfaction with care. Results: A total of 1600 patients were enrolled. The average age was 78 years, and 77% were women. A total of 73.5% (1050 of 1428) of patients reported severe pain during the first 24 hours after surgery. Worst pain over the first 24 hours after surgery was greater with spinal anesthesia (rated from 0 [no pain] to 10 [worst pain imaginable]; mean difference, 0.40 [95% CI, 0.12 to 0.68]). Pain did not differ across groups at other time points. Prescription analgesic use at 60 days occurred in 25% (141 of 563) and 18.8% (108 of 574) of patients assigned to spinal and general anesthesia, respectively (relative risk, 1.33 [CI, 1.06 to 1.65]). Satisfaction was similar across groups. Limitation: Missing outcome data and multiple outcomes assessed. Conclusion: Severe pain is common after hip fracture. Spinal anesthesia was associated with more pain in the first 24 hours after surgery and more prescription analgesic use at 60 days compared with general anesthesia.

引用

页码：952 / +

页数：13

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