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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 952-960 |
| Number of pages | 9 |
| Journal | Annals of internal medicine |
| Volume | 176 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2023 |
Funding
The REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) trial was funded by the Patient-Centered Outcomes Research Institute. The study design and primary outcome analyses have been described previously (4, 10). We worked with patients and stakeholders to select outcomes of importance to patients (11). The institutional review board of the University of Pennsylvania approved the protocol and was the institutional review board of record for 11 sites; approval at other sites was via local institutional review board review (12). Written informed consent was obtained from the participant or, for persons who could not provide consent, from their health care proxy.
ASJC Scopus subject areas
- Internal Medicine