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

Authors

Mark D Neuman
Rui Feng
Susan S Ellenberg
Frederick Sieber
Daniel I Sessler
Jay Magaziner
Nabil Elkassabany
Eric S Schwenk
Derek Dillane
Edward R Marcantonio
Diane Menio
Sabry Ayad
Manal Hassan
Trevor Stone
Steven Papp
Derek Donegan
Mitchell Marshall
J Douglas Jaffe
Charles Luke
Balram Sharma
Syed Azim
Robert Hymes
Ki-Jinn Chin
Richard Sheppard
Barry Perlman
Joshua Sappenfield
Ellen Hauck
Mark A Hoeft
Ann Tierney
Lakisha J Gaskins
Annamarie D Horan
Trina Brown
James Dattilo
Jeffrey L Carson
Thomas Looke
Sandra Bent
Ariana Franco-Mora
Pamela Hedrick
Matthew Newbern
Rafik Tadros
Karen Pealer
Kamen Vlassakov
Carolyn Buckley
Lauren Gavin
Svetlana Gorbatov
James Gosnell
Talora Steen
Avery Vafai
Jose Zeballos
Jennifer Hruslinski
Louis Cardenas
Ashley Berry
John Getchell
Nicholas Quercetti
Gauasan Bajracharya
Damien Billow
Michael Bloomfield
Evis Cuko
Mehrun K Elyaderani
Robert Hampton
Hooman Honar
Dilara Khoshknabi
Daniel Kim
David Krahe
Michael M Lew
Conjeevram B Maheshwer
Azfar Niazi
Partha Saha
Ahmed Salih
Robert J de Swart
Andrew Volio
Kelly Bolkus
Matthew DeAngelis
Gregory Dodson
Jeffrey Gerritsen
Brian McEniry
Ludmil Mitrev
M Kwesi Kwofie
Anne Belliveau
Flynn Bonazza
Vera Lloyd
Izabela Panek
Jared DabiriFollow
Chris Chavez
Jason Craig
Todd Davidson
Chad Dietrichs
Cheryl Fleetwood
Mike Foley
Chris Getto
Susie Hailes
Sarah Hermes
Andy Hooper
Greg Koener
Kate Kohls
Leslie Law
Adam Lipp
Allison Losey
William Nelson
Mario Nieto
Pam Rogers
Steve Rutman
Garrett Scales
Barbara Sebastian
Tom Stanciu
Gregg Lobel
Michelle Giampiccolo
Dara Herman
Margit Kaufman
Bryan Murphy
Clara Pau
Thomas Puzio
Marlene Veselsky
Kelly Apostle
Dory Boyer
Brenda Chen Fan
Susan Lee
Mike Lemke
Richard Merchant
Farhad Moola
Kyrsten Payne
Bertrand Perey
Darius Viskontas
Mark Poler
Patricia D'Antonio
Greg O'Neill
Amer Abdullah
Jamie Fish-Fuhrmann
Mark Giska
Christina Fidkowski
Stuart Trent Guthrie
William Hakeos
Lillian Hayes
Joseph Hoegler
Katherine Nowak
Jeffery Beck
Jaslynn Cuff
Greg Gaski
Sharon Haaser
Michael Holzman
A Stephen Malekzadeh
Lolita Ramsey
Jeff Schulman
Cary Schwartzbach
Tangwan Azefor
Arman Davani
Mahmood Jaberi
Courtney Masear
Syed Basit Haider
Carolyn Chungu
Ali Ebrahimi
Karim Fikry
Andrew Marcantonio
Anitha Shelvan
David Sanders
Collin Clarke
Abdel Lawendy
Gary Schwartz
Mohit Garg
Joseph Kim
Juan Caruci
Ekow Commeh
Randy Cuevas
Germaine Cuff
Lola Franco
David Furgiuele
Matthew Giuca
Melissa Allman
Omid Barzideh
James Cossaro
Armando D'Arduini
Anita Farhi
Jason Gould
John Kafel
Anuj Patel
Abraham Peller
Hadas Reshef
Mohammed Safur
Fiore Toscano
Tiffany Tedore
Michael Akerman
Eric Brumberger
Sunday Clark
Rachel Friedlander
Anita Jegarl
Joseph Lane
John P Lyden
Nili Mehta
Matthew T Murrell
Nathan Painter
William Ricci
Kaitlyn Sbrollini
Rahul Sharma
Peter A D Steel
Michele Steinkamp
Roniel Weinberg
David Stephenson Wellman
Antoun Nader
Paul Fitzgerald
Michaela Ritz
Greg Bryson
Alexandra Craig
Cassandra Farhat
Braden Gammon
Wade Gofton
Nicole Harris
Karl Lalonde
Allan Liew
Bradley Meulenkamp
Kendra Sonnenburg
Eugene Wai
Geoffrey Wilkin
Karen Troxell
Mary Ellen Alderfer
Jason Brannen
Christopher Cupitt
Stacy Gerhart
Renee McLin
Julie Sheidy
Katherine Yurick
Fei Chen
Karen Dragert
Geza Kiss
Halina Malveaux
Deborah McCloskey
Scott Mellender
Sagar S Mungekar
Helaine Noveck
Carlos Sagebien
Luat Biby
Gail McKelvy
Anna Richards
Ramon Abola
Brittney Ayala
Darcy Halper
Ana Mavarez
Sabeen Rizwan
Stephen Choi
Imad Awad
Brendan Flynn
Patrick Henry
Richard Jenkinson
Lilia Kaustov
Elizabeth Lappin
Paul McHardy
Amara Singh
Joanne Donnelly
Meera Gonzalez
Christopher Haydel
Jon Livelsberger
Theresa Pazionis
Bridget Slattery
Maritza Vazquez-Trejo
Jaime Baratta
Michael Cirullo
Brittany Deiling
Laura N Deschamps DO, Lehigh Valley Health NetworkFollow
Michael Glick
Daniel Katz
James Krieg
Jennifer Lessin
Jeffrey Mojica
Marc Torjman
Rongyu Jin
Mary Jane Salpeter
Mark Powell
Jeffrey Simmons
Prentiss Lawson
Promil Kukreja
Shanna Graves
Adam Sturdivant
Ayesha Bryant
Sandra Joyce Crump
Michelle Verrier
James Green
Matthew Menon
Richard Applegate
Ana Arias
Natasha Pineiro
Jeffrey Uppington
Phillip Wolinsky
Amy Gunnett
Jennifer Hagen
Sara Harris
Kevin Hollen
Brian Holloway
Mary Beth Horodyski
Trevor Pogue
Ramachandran Ramani
Cameron Smith
Anna Woods
Matthew Warrick
Kelly Flynn
Paul Mongan
Yatish Ranganath
Sean Fernholz
Esperanza Ingersoll-Weng
Anil Marian
Melinda Seering
Zita Sibenaller
Lori Stout
Allison Wagner
Alicia Walter
Cynthia Wong
Denise Orwig
Maithri Goud
Chris Helker
Lydia Mezenghie
Brittany Montgomery
Peter Preston
J Sanford Schwartz
Ramona Weber
Lee A Fleisher
Samir Mehta
Alisa J Stephens-Shields
Cassandra Dinh
Jacques E Chelly
Shiv Goel
Wende Goncz
Touichi Kawabe
Sharad Khetarpal
Amy Monroe
Vladislav Shick
Max Breidenstein
Timothy Dominick
Alexander Friend
Donald Mathews
Richard Lennertz
Robert Sanders
Helen Akere
Tyler Balweg
Amber Bo
Christopher Doro
David Goodspeed
Gerald Lang
Maggie Parker
Amy Rettammel
Mary Roth
Marissa White
Paul Whiting
Brian F S Allen
Tracie Baker
Debra Craven
Matt McEvoy
Teresa Turnbo
Stephen Kates
Melanie Morgan
Teresa Willoughby
Wade Weigel
David Auyong
Ellie Fox
Tina Welsh
Bruce Cusson
Sean Dobson
Christopher Edwards
Lynette Harris
Daryl Henshaw
Kathleen Johnson
Glen McKinney
Scott Miller
Jon Reynolds
B Scott Segal
Jimmy Turner
David VanEenenaam
Robert Weller
Jineli Lei
Miriam Treggiari
Shamsuddin Akhtar
Marcelle Blessing
Chanel Johnson
Michael Kampp
Kimberly Kunze
Mary O'Connor
Thomas Looke
Rafik Tadros
Kamen Vlassakov
Louis Cardenas
Kelly Bolkus
Ludmil Mitrev
M Kwesi Kwofie
Jared DabiriFollow
Gregg Lobel
Mark Poler
Mark Giska
David Sanders
Gary Schwartz
Matthew Giuca
Tiffany Tedore
Antoun Nader
Greg Bryson
Karen Troxell
Geza Kiss
Stephen Choi
Mark Powell
Richard Applegate
Matthew Warrick
Yatish Ranganath
Jacques E Chelly
Richard Lennertz
Robert Sanders
Brian F S Allen
Stephen Kates
Wade Weigel
Jinlei Li
Duminda N Wijeysundera
Sachin Kheterpal
Reneé H Moore
Alexander K Smith
Laura L Tosi
Thomas Looke
Samir Mehta
Lee Fleisher
Jennifer Hruslinski
Lolita Ramsey
Christine Langlois
Lydia Mezenghie
Brittany Montgomery
Samuel Oduwole
Thomas Rose

Publication/Presentation Date

7-1-2022

Abstract

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.

PRIMARY FUNDING SOURCE: Patient-Centered Outcomes Research Institute

Volume

175

Issue

7

First Page

952

Last Page

960

ISSN

1539-3704

Disciplines

Medicine and Health Sciences

PubMedID

35696684

Department(s)

Department of Medicine

Document Type

Article

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