Spinal anaesthesia was associated with more pain in the first 24 hours after hip fracture surgery and more prescription analgesic use at 60 days compared with general anaesthesia, according to a study published in the Annals of Internal Medicine.
“In our study, patients who got spinal anaesthesia did get fewer opioids in the operating room, but they ended up having more pain, and more prescription pain medication use after surgery,” said lead author Mark Neuman, MD, Penn Medicine Opioid Task Force, Philadelphia, Pennsylvania. “While our study can’t determine conclusively whether this was due to the spinal anaesthesia 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.”
For the REGAIN trial, 1,600 patients undergoing hip fracture surgery between 2016 and 2021 at dozens of hospitals across the United States and Canada were randomised to receive spinal anaesthesia or general anaesthesia. Each patient was asked to assess their levels of pain on a scale of 1 to 10 at varying intervals, and to indicate their opioid use following the procedure.
Overall, patients rated their worst pain in the day following their procedure, with the patients in the spinal anaesthesia group indicating slightly higher levels of their worst pain, averaging 7.9 out of 10 compared with 7.6 among those in the general anaesthesia group.
After that, patients in the spinal anaesthesia group were 33% more likely than the general anaesthesia group to have still taken prescription painkillers roughly 2 months out from their procedure. There was not a significant difference noticed in prescription pain medicine use at 6 and 12 months after the surgery, but Dr. Neuman was still wary of what he saw.
“Even though the 180- and 365-day findings are not statistically significant, the 60-day finding is still concerning, since there could be medication-related harms like respiratory depression or over-sedation that could still occur over the short term,” he said.
The researchers hope to improve pain care for patients with hip fracture by finding ways to increase use of peripheral nerve blocks.