Department of Anesthesiology and Critical Care, Perelman School of Medicine, and Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (M.D.N., N.E., L.J.G.).
Department of Biostatistics, Epidemiology, and Informatics, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (R.F., S.S.E.).
Ann Intern Med. 2022 Jul;175(7):952-960. doi: 10.7326/M22-0320. Epub 2022 Jun 14.
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.
To compare pain, analgesic use, and satisfaction after hip fracture surgery with spinal versus general anesthesia.
Preplanned secondary analysis of a pragmatic randomized trial. (ClinicalTrials.gov: NCT02507505).
46 U.S. and Canadian hospitals.
Patients aged 50 years or older undergoing hip fracture surgery.
Spinal or general anesthesia.
Pain on postoperative days 1 through 3; 60-, 180-, and 365-day pain and prescription analgesic use; and satisfaction with care.
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.
Missing outcome data and multiple outcomes assessed.
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.
Patient-Centered Outcomes Research Institute
REGAIN（椎管内麻醉与全身麻醉在促进髋部骨折后独立中的比较）试验发现，对于髋部骨折手术，椎管内麻醉与全身麻醉在 60 天时的活动能力和生存率相似。目前尚未报告评估疼痛、处方镇痛药使用和患者满意度的试验结果。
比较椎管内麻醉与全身麻醉对髋部骨折手术后疼痛、镇痛药使用和满意度的影响。
实用随机试验的预先计划的二次分析。（ClinicalTrials.gov：NCT02507505）。
46 家美国和加拿大医院。
年龄在 50 岁或以上，接受髋部骨折手术的患者。
椎管内或全身麻醉。
术后第 1 天至第 3 天的疼痛；60、180 和 365 天的疼痛和处方镇痛药使用；以及对护理的满意度。
共纳入 1600 例患者。平均年龄为 78 岁，77%为女性。共有 73.5%（1428 例中的 1050 例）患者报告在术后 24 小时内出现严重疼痛。术后 24 小时内最严重的疼痛在椎管内麻醉时更大（从 0[无痛]到 10[可想象的最严重疼痛]；平均差异为 0.40[95%CI，0.12 至 0.68]）。在其他时间点，各组之间的疼痛没有差异。在 60 天时，分别有 25%（141/563 例）和 18.8%（108/574 例）接受椎管内和全身麻醉的患者使用了处方镇痛药（相对风险，1.33[CI，1.06 至 1.65]）。各组之间的满意度相似。
存在缺失数据和多项评估结果。
髋部骨折后疼痛常见。与全身麻醉相比，椎管内麻醉在术后 24 小时内疼痛更剧烈，60 天时使用处方镇痛药更多。
患者导向结果研究所。
