General vs. Spinal Anesthesia in Hip Fractures. Which Wins?

According to a team of researchers at the Department of Anesthesiology and Critical Care at the University of Pennsylvania’s Perelman School of Medicine, we don’t know enough about general vs. spinal anesthesia for hip fracture patients. So, of course, they put together a randomized study and collected post-op pain data for 1,600 hip fracture patients at 46 hospitals around the US and Canada.

The details of their study and results were published in the June 14, 2022, edition of the Annals of Internal Medicine under the title, “Pain, Analgesic Use, and Patient Satisfaction With Spinal Versus General Anesthesia for Hip Fracture Surgery.”

Mark D. Neuman, M.D., M.Sc., co-author and a member of the Perelman School of Medicine’s Department of Anesthesiology and Critical Care explained to OTW the genesis of this important study. “Spinal and general anesthesia have each been used in orthopedic surgery for decades, yet most past trials have not examined differences in patients’ experience of pain and satisfaction with care. Our study aimed to fill that gap in order to improve decision-making by patients and clinicians about their anesthesia choices.”

Neuman and his colleagues around the U.S. and Canada enrolled 1,600 patients in this, a “pre-planned secondary analysis of a multicenter pragmatic randomized trial comparing spinal versus general anesthesia for hip fracture surgery.”

The team pulled data from ER registration lists, hospital admission lists, and surgical case schedules at 46 hospitals. The team selected patients who were 50 years or older and were scheduled to undergo surgical repair of a clinically or radiographically diagnosed femoral neck, intertrochanteric, or subtrochanteric hip fracture.

Patients in the spinal anesthesia group (795) received one spinal anesthetic with sedation and were allowed to be converted by their care team to general anesthesia if required based on clinical circumstances or patient request. Patients in the general anesthesia group (805) received an inhaled anesthesia and an endotracheal tube, supraglottic airway, or other device for airway management.

Results: Mega Pain at 24 Hours, Spinal Worse Than General

“Most importantly,” explained Dr. Neuman to OTW, “we found that severe pain is common after hip fracture—over 73% of patients in our sample rated their worst pain over the first 24 hours after surgery as severe. We also found that spinal anesthesia was associated with more pain in the first 24 hours after surgery and more prescription analgesic use at 60 days compared to general anesthesia, although satisfaction was similar across groups.”

“Most of all, our hope is that this information can help to improve discussions between patients and physicians regarding anesthesia choices. Our work highlights a need for further research to validate our findings and explore the relationship between anesthesia technique, postoperative pain management, and patterns of analgesic use after hip fracture surgery.”