Your browser doesn't support javascript.
loading
Pain, Analgesic Use, and Patient Satisfaction With Spinal Versus General Anesthesia for Hip Fracture Surgery : A Randomized Clinical Trial.
Neuman, Mark D; Feng, Rui; Ellenberg, Susan S; Sieber, Frederick; Sessler, Daniel I; Magaziner, Jay; Elkassabany, Nabil; Schwenk, Eric S; Dillane, Derek; Marcantonio, Edward R; Menio, Diane; Ayad, Sabry; Hassan, Manal; Stone, Trevor; Papp, Steven; Donegan, Derek; Marshall, Mitchell; Jaffe, J Douglas; Luke, Charles; Sharma, Balram; Azim, Syed; Hymes, Robert; Chin, Ki-Jinn; Sheppard, Richard; Perlman, Barry; Sappenfield, Joshua; Hauck, Ellen; Hoeft, Mark A; Tierney, Ann; Gaskins, Lakisha J; Horan, Annamarie D; Brown, Trina; Dattilo, James; Carson, Jeffrey L; Looke, Thomas; Bent, Sandra; Franco-Mora, Ariana; Hedrick, Pamela; Newbern, Matthew; Tadros, Rafik; Pealer, Karen; Vlassakov, Kamen; Buckley, Carolyn; Gavin, Lauren; Gorbatov, Svetlana; Gosnell, James; Steen, Talora; Vafai, Avery; Zeballos, Jose; Hruslinski, Jennifer.
Afiliação
  • Neuman MD; 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.).
  • Feng R; 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.).
  • Ellenberg SS; 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.).
  • Sieber F; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland (F.S.).
  • Sessler DI; Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (D.I.S., S. Ayad, M.H.).
  • Magaziner J; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland (J.M.).
  • Elkassabany N; 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.).
  • Schwenk ES; Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (E.S.S.).
  • Dillane D; Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada (D. Dillane).
  • Marcantonio ER; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (E.R.M.).
  • Menio D; Center for Advocacy for the Rights and Interests of the Elderly, Philadelphia, Pennsylvania (D.M.).
  • Ayad S; Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (D.I.S., S. Ayad, M.H.).
  • Hassan M; Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (D.I.S., S. Ayad, M.H.).
  • Stone T; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada (T.S.).
  • Papp S; Division of Orthopaedics, Ottawa Hospital Civic Campus, Ottawa, Ontario, Canada (S.P.).
  • Donegan D; Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (D. Donegan).
  • Marshall M; Department of Anesthesiology, New York University Langone Medical Center, New York, New York (M.M.).
  • Jaffe JD; Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina (J.D.J.).
  • Luke C; Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (C.L.).
  • Sharma B; Department of Anesthesiology, Lahey Hospital and Medical Center, Burlington, Massachusetts (B.S.).
  • Azim S; Department of Anesthesiology, Stony Brook University, Stony Brook, New York (S. Azim).
  • Hymes R; Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia (R.H.).
  • Chin KJ; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada (K.C.).
  • Sheppard R; Department of Anesthesiology, Hartford Hospital, Hartford, Connecticut (R.S.).
  • Perlman B; Oregon Health and Science University, Portland, Oregon (B.P.).
  • Sappenfield J; Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida (J.S.).
  • Hauck E; Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania (E.H.).
  • Hoeft MA; Department of Anesthesiology, University of Vermont Larner College of Medicine, Burlington, Vermont (M.A.H.).
  • Tierney A; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (A.T., T.B., J.D.).
  • Gaskins LJ; 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.).
  • Horan AD; Department of Anesthesiology and Critical Care, Perelman School of Medicine, and Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (A.D.H.).
  • Brown T; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (A.T., T.B., J.D.).
  • Dattilo J; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (A.T., T.B., J.D.).
  • Carson JL; Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (J.L.C.).
Ann Intern Med ; 175(7): 952-960, 2022 07.
Article em En | MEDLINE | ID: mdl-35696684
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.
Assuntos
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Fraturas do Quadril / Raquianestesia Tipo de estudo: Clinical_trials / Etiology_studies Limite: Aged / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: Ann Intern Med Ano de publicação: 2022 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Fraturas do Quadril / Raquianestesia Tipo de estudo: Clinical_trials / Etiology_studies Limite: Aged / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: Ann Intern Med Ano de publicação: 2022 Tipo de documento: Article