Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.
Reg Anesth Pain Med. 2023 Aug;48(8):430-432. doi: 10.1136/rapm-2022-104071. Epub 2023 Mar 28.
Two recent, large-scale, randomized controlled trials comparing neuraxial anesthesia with general anesthesia for patients undergoing surgical fixation of a hip fracture have sparked interest in the comparison of general and neuraxial anesthesia. These studies both reported non-superiority between general and neuraxial anesthesia in this patient cohort, yet they have limitations, like their sample size and use of composite outcomes. We worry that that if there is a perception among surgeons, nurses, patients and anesthesiologists that general and spinal anesthesia are equivalent (which is not what the authors of the studies conclude), it may become difficult to argue for the resources and training to provide neuraxial anesthesia to this patient population. In this daring discourse, we argue that despite the recent trials, there remain benefits of neuraxial anesthesia for patients who have suffered hip fractures and that abandoning offering neuraxial anesthesia to these patients would be an error.
最近两项大型、随机对照试验比较了神经轴麻醉与全身麻醉在接受髋关节骨折手术固定的患者中的应用，这激发了人们对全身麻醉与神经轴麻醉比较的兴趣。这两项研究都报告了在该患者人群中全身麻醉与神经轴麻醉之间没有优越性，但它们存在局限性，例如样本量和复合结局的使用。我们担心，如果外科医生、护士、患者和麻醉师普遍认为全身麻醉和脊髓麻醉是等效的（这与研究作者的结论不同），那么可能难以争取资源和培训来为这一患者群体提供神经轴麻醉。在这篇大胆的论述中，我们认为，尽管最近有这些试验，神经轴麻醉对髋关节骨折患者仍有好处，放弃为这些患者提供神经轴麻醉将是一个错误。
