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More pain, medication use seen with spinal vs. general anesthesia for hip fracture surgery

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Source/Disclosures

Disclosures:
Neuman reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.


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Published results showed use of spinal anesthesia during hip fracture surgery led to more pain in the first 24 hours and use of more prescription analgesia at 60 days compared with general anesthesia.

“In our study, patients who got spinal anesthesia did get fewer opioids in the operating room, but they ended up having more pain and more prescription pain medication use after surgery,” Mark D. Neuman, MD, MSc, lead author of the study and associate professor of anesthesiology and past chair of the Penn Medicine Opioid Task Force, said in a press release from the University of Pennsylvania. “While our study can’t determine conclusively whether this was due to the spinal anesthesia itself or the fact that fewer opioids were given up front, this is a result that should make people examine some of the assumptions informing current care pathways.”

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Results showed 25% of patients who received spinal anesthesia and 18.8% of patients who received general anesthesia during hip fracture surgery reported prescription analgesic use at 60 days postoperatively. Data were derived from Neuman MD, et al. Ann Intern Med. 2022;doi:10.7326/M22-0320.

Neuman and colleagues randomly assigned 1,600 patients aged 50 years or older scheduled to undergo surgical repair of a clinically or radiographically diagnosed femoral neck, intertrochanteric or subtrochanteric hip fracture to receive either spinal anesthesia (n=795) or general anesthesia (n=805). Outcome measurements included patient pain on postoperative days 1 through 3, patient pain and prescription analgesic use at 60-, 180- and 365-days and patient satisfaction with care.

Results showed 73% of patients reported severe pain during the first 24 hours after surgery, with patients who received spinal anesthesia reporting worse pain during the first 24 hours after surgery. However, researchers found the groups had no differences in pain at other time points. Researchers noted 25% of patients in the spinal anesthesia group and 18.8% of patients in the general anesthesia group reported prescription analgesic use at 60 days postoperatively. Both groups reported similar satisfaction, according to results.

References

Neuman MD, et al. Ann Intern Med. 2022;doi:10.7326/M22-0320.

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