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Randomized Controlled Trial
. 2022 Jul;175(7):952-960.
doi: 10.7326/M22-0320. Epub 2022 Jun 14.

Pain, Analgesic Use, and Patient Satisfaction With Spinal Versus General Anesthesia for Hip Fracture Surgery : A Randomized Clinical Trial

Mark D Neuman  1 , Rui Feng  2 , Susan S Ellenberg  2 , Frederick Sieber  3 , Daniel I Sessler  4 , Jay Magaziner  5 , Nabil Elkassabany  1 , Eric S Schwenk  6 , Derek Dillane  7 , Edward R Marcantonio  8 , Diane Menio  9 , Sabry Ayad  4 , Manal Hassan  4 , Trevor Stone  10 , Steven Papp  11 , Derek Donegan  12 , Mitchell Marshall  13 , J Douglas Jaffe  14 , Charles Luke  15 , Balram Sharma  16 , Syed Azim  17 , Robert Hymes  18 , Ki-Jinn Chin  19 , Richard Sheppard  20 , Barry Perlman  21 , Joshua Sappenfield  22 , Ellen Hauck  23 , Mark A Hoeft  24 , Ann Tierney  25 , Lakisha J Gaskins  1 , Annamarie D Horan  26 , Trina Brown  25 , James Dattilo  25 , Jeffrey L Carson  27 ; REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) Investigators*; Thomas Looke, Sandra Bent, Ariana Franco-Mora, Pamela Hedrick, Matthew Newbern, Rafik Tadros, Karen Pealer, Kamen Vlassakov, Carolyn Buckley, Lauren Gavin, Svetlana Gorbatov, James Gosnell, Talora Steen, Avery Vafai, Jose Zeballos, Jennifer Hruslinski, Louis Cardenas, Ashley Berry, John Getchell, Nicholas Quercetti, Gauasan Bajracharya, Damien Billow, Michael Bloomfield, Evis Cuko, Mehrun K Elyaderani, Robert Hampton, Hooman Honar, Dilara Khoshknabi, Daniel Kim, David Krahe, Michael M Lew, Conjeevram B Maheshwer, Azfar Niazi, Partha Saha, Ahmed Salih, Robert J de Swart, Andrew Volio, Kelly Bolkus, Matthew DeAngelis, Gregory Dodson, Jeffrey Gerritsen, Brian McEniry, Ludmil Mitrev, M Kwesi Kwofie, Anne Belliveau, Flynn Bonazza, Vera Lloyd, Izabela Panek, Jared Dabiri, Chris Chavez, Jason Craig, Todd Davidson, Chad Dietrichs, Cheryl Fleetwood, Mike Foley, Chris Getto, Susie Hailes, Sarah Hermes, Andy Hooper, Greg Koener, Kate Kohls, Leslie Law, Adam Lipp, Allison Losey, William Nelson, Mario Nieto, Pam Rogers, Steve Rutman, Garrett Scales, Barbara Sebastian, Tom Stanciu, Gregg Lobel, Michelle Giampiccolo, Dara Herman, Margit Kaufman, Bryan Murphy, Clara Pau, Thomas Puzio, Marlene Veselsky, Kelly Apostle, Dory Boyer, Brenda Chen Fan, Susan Lee, Mike Lemke, Richard Merchant, Farhad Moola, Kyrsten Payne, Bertrand Perey, Darius Viskontas, Mark Poler, Patricia D'Antonio, Greg O'Neill, Amer Abdullah, Jamie Fish-Fuhrmann, Mark Giska, Christina Fidkowski, Stuart Trent Guthrie, William Hakeos, Lillian Hayes, Joseph Hoegler, Katherine Nowak, Jeffery Beck, Jaslynn Cuff, Greg Gaski, Sharon Haaser, Michael Holzman, A Stephen Malekzadeh, Lolita Ramsey, Jeff Schulman, Cary Schwartzbach, Tangwan Azefor, Arman Davani, Mahmood Jaberi, Courtney Masear, Syed Basit Haider, Carolyn Chungu, Ali Ebrahimi, Karim Fikry, Andrew Marcantonio, Anitha Shelvan, David Sanders, Collin Clarke, Abdel Lawendy, Gary Schwartz, Mohit Garg, Joseph Kim, Juan Caruci, Ekow Commeh, Randy Cuevas, Germaine Cuff, Lola Franco, David Furgiuele, Matthew Giuca, Melissa Allman, Omid Barzideh, James Cossaro, Armando D'Arduini, Anita Farhi, Jason Gould, John Kafel, Anuj Patel, Abraham Peller, Hadas Reshef, Mohammed Safur, Fiore Toscano, Tiffany Tedore, Michael Akerman, Eric Brumberger, Sunday Clark, Rachel Friedlander, Anita Jegarl, Joseph Lane, John P Lyden, Nili Mehta, Matthew T Murrell, Nathan Painter, William Ricci, Kaitlyn Sbrollini, Rahul Sharma, Peter A D Steel, Michele Steinkamp, Roniel Weinberg, David Stephenson Wellman, Antoun Nader, Paul Fitzgerald, Michaela Ritz, Greg Bryson, Alexandra Craig, Cassandra Farhat, Braden Gammon, Wade Gofton, Nicole Harris, Karl Lalonde, Allan Liew, Bradley Meulenkamp, Kendra Sonnenburg, Eugene Wai, Geoffrey Wilkin, Karen Troxell, Mary Ellen Alderfer, Jason Brannen, Christopher Cupitt, Stacy Gerhart, Renee McLin, Julie Sheidy, Katherine Yurick, Fei Chen, Karen Dragert, Geza Kiss, Halina Malveaux, Deborah McCloskey, Scott Mellender, Sagar S Mungekar, Helaine Noveck, Carlos Sagebien, Luat Biby, Gail McKelvy, Anna Richards, Ramon Abola, Brittney Ayala, Darcy Halper, Ana Mavarez, Sabeen Rizwan, Stephen Choi, Imad Awad, Brendan Flynn, Patrick Henry, Richard Jenkinson, Lilia Kaustov, Elizabeth Lappin, Paul McHardy, Amara Singh, Joanne Donnelly, Meera Gonzalez, Christopher Haydel, Jon Livelsberger, Theresa Pazionis, Bridget Slattery, Maritza Vazquez-Trejo, Jaime Baratta, Michael Cirullo, Brittany Deiling, Laura Deschamps, Michael Glick, Daniel Katz, James Krieg, Jennifer Lessin, Jeffrey Mojica, Marc Torjman, Rongyu Jin, Mary Jane Salpeter, Mark Powell, Jeffrey Simmons, Prentiss Lawson, Promil Kukreja, Shanna Graves, Adam Sturdivant, Ayesha Bryant, Sandra Joyce Crump, Michelle Verrier, James Green, Matthew Menon, Richard Applegate, Ana Arias, Natasha Pineiro, Jeffrey Uppington, Phillip Wolinsky, Amy Gunnett, Jennifer Hagen, Sara Harris, Kevin Hollen, Brian Holloway, Mary Beth Horodyski, Trevor Pogue, Ramachandran Ramani, Cameron Smith, Anna Woods, Matthew Warrick, Kelly Flynn, Paul Mongan, Yatish Ranganath, Sean Fernholz, Esperanza Ingersoll-Weng, Anil Marian, Melinda Seering, Zita Sibenaller, Lori Stout, Allison Wagner, Alicia Walter, Cynthia Wong, Denise Orwig, Maithri Goud, Chris Helker, Lydia Mezenghie, Brittany Montgomery, Peter Preston, J Sanford Schwartz, Ramona Weber, Lee A Fleisher, Samir Mehta, Alisa J Stephens-Shields, Cassandra Dinh, Jacques E Chelly, Shiv Goel, Wende Goncz, Touichi Kawabe, Sharad Khetarpal, Amy Monroe, Vladislav Shick, Max Breidenstein, Timothy Dominick, Alexander Friend, Donald Mathews, Richard Lennertz, Robert Sanders, Helen Akere, Tyler Balweg, Amber Bo, Christopher Doro, David Goodspeed, Gerald Lang, Maggie Parker, Amy Rettammel, Mary Roth, Marissa White, Paul Whiting, Brian F S Allen, Tracie Baker, Debra Craven, Matt McEvoy, Teresa Turnbo, Stephen Kates, Melanie Morgan, Teresa Willoughby, Wade Weigel, David Auyong, Ellie Fox, Tina Welsh, Bruce Cusson, Sean Dobson, Christopher Edwards, Lynette Harris, Daryl Henshaw, Kathleen Johnson, Glen McKinney, Scott Miller, Jon Reynolds, B Scott Segal, Jimmy Turner, David VanEenenaam, Robert Weller, Jineli Lei, Miriam Treggiari, Shamsuddin Akhtar, Marcelle Blessing, Chanel Johnson, Michael Kampp, Kimberly Kunze, Mary O'Connor, Thomas Looke, Rafik Tadros, Kamen Vlassakov, Louis Cardenas, Kelly Bolkus, Ludmil Mitrev, M Kwesi Kwofie, Jared Dabiri, Gregg Lobel, Mark Poler, Mark Giska, David Sanders, Gary Schwartz, Matthew Giuca, Tiffany Tedore, Antoun Nader, Greg Bryson, Karen Troxell, Geza Kiss, Stephen Choi, Mark Powell, Richard Applegate, Matthew Warrick, Yatish Ranganath, Jacques E Chelly, Richard Lennertz, Robert Sanders, Brian F S Allen, Stephen Kates, Wade Weigel, Jinlei Li, Duminda N Wijeysundera, Sachin Kheterpal, Reneé H Moore, Alexander K Smith, Laura L Tosi, Thomas Looke, Samir Mehta, Lee Fleisher, Jennifer Hruslinski, Lolita Ramsey, Christine Langlois, Lydia Mezenghie, Brittany Montgomery, Samuel Oduwole, Thomas Rose; REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Pain, Analgesic Use, and Patient Satisfaction With Spinal Versus General Anesthesia for Hip Fracture Surgery : A Randomized Clinical Trial

Mark D Neuman et al. Ann Intern Med. 2022 Jul.

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.

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