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

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.

EVENTRAŢIA DIAFRAGMULUI – FACTOR DE RISC PENTRU INFECŢIILE RESPIRATORII PREZENTARE DE CAZ

Eventraţia diafragmului este o anomalie congenitală sau dobândită, cu o incidenţă de 1 la 10.000 de copii. Presupune ascensiunea anormală a domului diafragmatic, datorată înlocuirii fi brelor musculare cu un ţesut fi broelastic în exces. Simptomatologia este variată, putând fi absentă sau sub forma unor acuze respiratorii ce pot merge până la detresă respiratorie. Infecţiile respiratorii recurente sunt cele mai frecvente manifestări. Autorii prezintă cazul unui pacient în vârstă de 3 ani de sex masculin, spitalizat în repetate rânduri pentru infecţii respiratorii, „dextrocardie“ aparentă, datorate unei eventraţii diafragmatice stângi, pentru care s-a realizat cu succes plicatura diafragmului.

EVENTRATION OF THE DIAPHRAGM, A RISK FACTOR FOR RECURRENT RESPIRATORY TRACT INFECTION – A CASE REPORT

Eventration of the diaphragm, congenital or acquired, represents a rare condition (1 to 10,000 live births), in which the dome of the diaphragm is abnormally elevated, due to an excessive amount of fi bro-elastic diaphragmatic tissue. The child may be asymptomatic or present with respiratory symptoms as aggressive as life threatening respiratory distress. Recurrent pulmonary infections are the commonest presenting complaints. We present the case of a 3 years old boy with recurrent chest infections and apparent “dextrocardia”, both caused by a left eventration of the diaphragm, successfully treated by plication.