Pain, Analgesic Use, and Patient Satisfaction With Spinal Versus General Anesthesia for Hip Fracture Surgery
Authors: Mark D. Neuman, Rui Feng, Susan S. Ellenberg, Frederick Sieber, Daniel I. Sessler, Jay Magaziner, Nabil Elkassabany, Eric S. Schwenk, Derek Dillane, Edward R. Marcantonio, Diane Menio, Sabry Ayad, Manal Salah Hassan, Trevor Stone, Steven Papp, Derek J. Donegan, Mitchell Marshall, J. Douglas Jaffe, Charles Luke, Balram Sharma, Syed Azim, Robert A. Hymes, Ki-Jinn Chin, Richard Sheppard, Barry B. Perlman, Joshua W. Sappenfield, Ellen Hauck, Mark A. Hoeft, Ann Tierney, Lakisha J. Gaskins, Annamarie D. Horan, Trina Brown, James Dattilo, Jeffrey L. Carson, 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 R. 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, Kwesi Kwofie, Anne C. 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 D Murphy, Clara Pau, Thomas Puzio, Marlene Veselsky, Kelly Apostle, Dory Boyer, Brenda Chen Fan, Susan Lee, Mike Lemke, Richard N. Merchant, Farhad Moola, Kyrsten Payne, Bertrand Perey, Darius G. Viskontas, Mark Poler, Patricia D’Antonio, Greg O’Neill, Amer Abdullah, Jamie Fish-Fuhrmann, Mark Giska, Christina W. Fidkowski, S. Trent Guthrie, William Hakeos, Lillian Hayes, Joseph Hoegler, Katherine Nowak, Jeffery Beck, Jaslynn Cuff, Greg E. Gaski, Sharon Haaser, Michael Holzman, Arjan Malekzadeh, Lolita Ramsey, Jeff E. Schulman, Cary C. 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 U. Patel, Abraham Peller, Hadas Reshef, Mohammed Safur, Fiore Toscano, Tiffany Tedore, Michael Akerman, Eric Brumberger, Sunday Clark, Rachel Friedlander, Anita Jegarl, Joseph M. Lane, John P. Lyden, Nili Mehta, Matthew T. Murrell, Nathan Painter, William M. Ricci, Kaitlyn Sbrollini, Rahul Sharma, Peter A.D. Steel, Michele Steinkamp, Roniel Weinberg, David S. Wellman, Antoun Nader, Paul C. Fitzgerald, Michaela Ritz, Greg Bryson, Alexandra Craig, Cassandra Farhat, Braden Gammon, Wade Gofton, Nicole Harris, Karl Lalonde, Allan Liew, Bradley Meulenkamp, Kendra Sonnenburg, Eugene K. Wai, Geoffrey Wilkin, Karen Troxell, Mary 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 C. Mavarez, Sabeen Rizwan, Stephen Choi, Imad T. Awad, Brendan P. 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 L. Baratta, Michael Cirullo, Brittany Deiling, Laura Deschamps, Michael Glick, Daniel Katz, James C. Krieg, J Lessin, Jeffrey Mojica, Marc C. Torjman, Rongyu Jin, Mary Jane Salpeter, Mark Powell, Jeffrey W. Simmons, Prentiss Lawson, Promil Kukreja, Shanna Graves, Adam Sturdivant, Ayesha Bryant, Sandra Joyce Crump, Michelle J. Verrier, James Green, Matthew Menon, Richard L. Applegate, Ana Carolina Amaya Arias, Natasha Pineiro, Jeffrey Uppington, Phillip Wolinsky, Amy Gunnett, Jennifer Hagen, Sara Harris, Kevin Hollen, Brian Holloway, MaryBeth Horodyski, Trevor Pogue, Ramachandran Ramani, Cameron Smith, Anna Woods, Matthew Warrick, Kelly Flynn, Paul Mongan, Yatish Ranganath, Sean Fernholz, Esperanza Ingersoll-Weng, Anil A. Marian, Melinda Seering, Zita A. Sibenaller, Lori Stout, Allison Wagner, Alicia Walter, Cynthia A. 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 W. Breidenstein, Timothy Dominick, Alexander T. Friend, Donald M. Mathews, Richard Lennertz, Robert D. Sanders, Helen Akere, Tyler Balweg, Amber Y. Bo, Christopher Doro, David Goodspeed, Gerald J. Lang, Maggie Parker, Amy Rettammel, Mary T. Roth, Marissa White, Paul S. Whiting, Brian F.S. Allen, Tracie Baker, Debra Craven, Matt McEvoy, Teresa Turnbo, Stephen Kates, Melanie Morgan, Teresa Willoughby, Wade Weigel, David B. Auyong, Ellie Fox, Tina Welsh, Bruce Cusson, Sean Dobson, Christopher J. Edwards, Lynette Harris, Daryl Henshaw, Kathleen N. Johnson, Glen Mckinney, Scott Miller, Jon Reynolds, B. Scott Segal, Jimmy Turner, David P. VanEenenaam, Robert S. Weller, Jineli Lei, Miriam M. 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, 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 L. Applegate, Matthew Warrick, Yatish Ranganath, Jacques E. Chelly, Richard Lennertz, Robert Sanders, Brian F.S. Allen, Stephen L. Kates, Wade Weigel, Jinlei Li, Duminda N. Wijeysundera, Sachin Kheterpal, Reneé H. Moore, Alexander K. Smith, Laura L. Tosi, Thomas Looke, Samir Mehta, Lee A. Fleisher, Jennifer Hruslinski, Lolita Ramsey, Christine Langlois, Lydia Mezenghie, Brittany Montgomery, Samuel Oduwole, Thomas Rose, 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 R. 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 C. 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 D Murphy, Clara Pau, Thomas Puzio, Marlene Veselsky, Kelly Apostle, Dory Boyer, Brenda Chen Fan, Susan Lee, Mike Lemke, Richard N. Merchant, Farhad Moola, Kyrsten Payne, Bertrand Perey, Darius G. Viskontas, Mark Poler, Patricia D’Antonio, Greg O’Neill, Amer Abdullah, Jamie Fish-Fuhrmann, Mark Giska, Christina W. Fidkowski, S. Trent Guthrie, William Hakeos, Lillian Hayes, Joseph Hoegler, Katherine Nowak, Jeffery Beck, Jaslynn Cuff, Greg E. Gaski, Sharon Haaser, Michael Holzman, Arjan Malekzadeh, Lolita Ramsey, Jeff E. Schulman, Cary C. 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 U. Patel, Abraham Peller, Hadas Reshef, Mohammed Safur, Fiore Toscano, Tiffany Tedore, Michael Akerman, Eric Brumberger, Sunday Clark, Rachel Friedlander, Anita Jegarl, Joseph M. Lane, John P. Lyden, Nili Mehta, Matthew T. Murrell, Nathan Painter, William M. Ricci, Kaitlyn Sbrollini, Rahul Sharma, Peter A.D. Steel, Michele Steinkamp, Roniel Weinberg, David S. Wellman, Antoun Nader, Paul C. Fitzgerald, Michaela Ritz, Greg Bryson, Alexandra Craig, Cassandra Farhat, Braden Gammon, Wade Gofton, Nicole Harris, Karl Lalonde, Allan Liew, Bradley Meulenkamp, Kendra Sonnenburg, Eugene K. Wai, Geoffrey Wilkin, Karen Troxell, Mary 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 C. Mavarez, Sabeen Rizwan, Stephen Choi, Imad T. Awad, Brendan P. 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 L. Baratta, Michael Cirullo, Brittany Deiling, Laura Deschamps, Michael Glick, Daniel Katz, James C. Krieg, J Lessin, Jeffrey Mojica, Marc C. Torjman, Rongyu Jin, Mary Jane Salpeter, Mark Powell, Jeffrey W. Simmons, Prentiss Lawson, Promil Kukreja, Shanna Graves, Adam Sturdivant, Ayesha Bryant, Sandra Joyce Crump, Michelle J. Verrier, James Green, Matthew Menon, Richard L. Applegate, Ana Carolina Amaya Arias, Natasha Pineiro, Jeffrey Uppington, Phillip Wolinsky, Amy Gunnett, Jennifer Hagen, Sara Harris, Kevin Hollen, Brian Holloway, MaryBeth Horodyski, Trevor Pogue, Ramachandran Ramani, Cameron Smith, Anna Woods, Matthew Warrick, Kelly Flynn, Paul Mongan, Yatish Ranganath, Sean Fernholz, Esperanza Ingersoll-Weng, Anil A. Marian, Melinda Seering, Zita A. Sibenaller, Lori Stout, Allison Wagner, Alicia Walter, Cynthia A. 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 W. Breidenstein, Timothy Dominick, Alexander T. Friend, Donald M. Mathews, Richard Lennertz, Robert Sanders, Helen Akere, Tyler Balweg, Amber Y. Bo, Christopher Doro, David Goodspeed, Gerald J. Lang, Maggie Parker, Amy Rettammel, Mary T. Roth, Marissa White, Paul S. Whiting, Brian F.S. Allen, Tracie Baker, Debra Craven, Matt McEvoy, Teresa Turnbo, Stephen L. Kates, Melanie Morgan, Teresa Willoughby, Wade Weigel, David B. Auyong, Ellie Fox, Tina Welsh, Bruce Cusson, Sean Dobson, Christopher J. Edwards, Lynette Harris, Daryl Henshaw, Kathleen N. Johnson, Glen Mckinney, Scott Miller, Jon Reynolds, B. Scott Segal, Jimmy Turner, David P. VanEenenaam, Robert S. Weller, Jineli Lei, Miriam M. 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, Kwesi Kwofie, Jared Dabiri, G 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 L. Applegate, Matthew Warrick, Yatish Ranganath, Jacques E. Chelly, Richard Lennertz, Robert D. 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 A. Fleisher, Jennifer Hruslinski, Lolita Ramsey, Christine Langlois, Lydia Mezenghie, Brittany Montgomery, Samuel Oduwole, Thomas Rose, Mark D. Neuman, Rui Feng, Susan S. Ellenberg, Frederick Sieber, Nabil Elkassabany, Eric S. Schwenk, Jay Magaziner, Derek Dillane, Daniel I. Sessler, Edward R. Marcantonio, Diane Menio, Sabry Ayad, Manal Salah Hassan, Trevor Stone, Steven Papp, Derek J. Donegan, Mitchell Marshall, J. Douglas Jaffe, Charles Luke, Balram Sharma, Syed Azim, Robert A. Hymes, Ki-Jinn Chin, Richard Sheppard, Barry B. Perlman, Joshua W. Sappenfield, Ellen Hauck, Mark A. Hoeft, Ann Tierney, Lakisha J. Gaskins, Annamarie D. Horan, Trina Brown, James Dattilo, Jeffrey L. Carson - Annals of Internal Medicine 2022 cited by 58
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