Pain, Analgesic Use, and Patient Satisfaction With Spinal Versus General Anesthesia for Hip Fracture Surgery : A Randomized Clinical Trial.
Journal
Annals of internal medicine
ISSN: 1539-3704
Titre abrégé: Ann Intern Med
Pays: United States
ID NLM: 0372351
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
pubmed:
14
6
2022
medline:
22
7
2022
entrez:
13
6
2022
Statut:
ppublish
Résumé
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
Sections du résumé
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
Substances chimiques
Analgesics
0
Banques de données
ClinicalTrials.gov
['NCT02507505']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
952-960Investigateurs
Thomas Looke
(T)
Sandra Bent
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Ariana Franco-Mora
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Pamela Hedrick
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Matthew Newbern
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Rafik Tadros
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Karen Pealer
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Kamen Vlassakov
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Carolyn Buckley
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Jennifer Hruslinski
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John Getchell
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Damien Billow
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Evis Cuko
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Robert Hampton
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Hooman Honar
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Dilara Khoshknabi
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Daniel Kim
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Partha Saha
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(K)
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