Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Reg Anesth Pain Med. 2023 Aug;48(8):428-429. doi: 10.1136/rapm-2023-104454. Epub 2023 Mar 28.
The debate over the optimal type of anesthesia for hip fracture surgery continues to rage. While retrospective evidence in elective total joint arthroplasty has suggested a reduction in complications with neuraxial anesthesia, previous retrospective studies in the hip fracture population have been mixed. Recently, two multicenter randomized, controlled trials (REGAIN and RAGA) have been published that examined delirium, ambulation at 60 days, and mortality in patients with hip fractures who were randomized to spinal or general anesthesia. These trials enrolled a combined 2,550 patients and found that spinal anesthesia did not confer a mortality benefit nor a reduction in delirium or greater proportion who could ambulate at 60 days. While these trials were not perfect, they call into question the practice of telling patients that spinal anesthesia is a "safer" choice for their hip fracture surgery. We believe a risk/benefit discussion should take place with each patient and that ultimately the patient should choose his or her anesthesia type after being informed of the state of the evidence. General anesthesia is an acceptable choice for hip fracture surgery.
对于髋关节骨折手术的最佳麻醉类型的争论仍在继续。虽然择期全膝关节置换术的回顾性证据表明神经轴麻醉可降低并发症发生率，但先前髋关节骨折患者的回顾性研究结果不一。最近，两项多中心随机对照试验（REGAIN 和 RAGA）发表，研究了接受随机分组为脊髓或全身麻醉的髋关节骨折患者的谵妄、60 天内的活动能力和死亡率。这两项试验共纳入了 2550 名患者，发现脊髓麻醉并未带来死亡率的益处，也没有减少谵妄或更多能够在 60 天内活动的患者比例。虽然这些试验并不完美，但它们质疑了告诉患者脊髓麻醉是他们髋关节骨折手术“更安全”选择的做法。我们认为应该与每位患者进行风险/收益讨论，最终患者应该在了解证据状况后选择他或她的麻醉类型。全身麻醉是髋关节骨折手术的一种可接受的选择。
