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Daring discourse
There remains a role for neuraxial anesthesia for hip fracture surgery in the post-REGAIN era
  1. Alexander B Stone1,2,
  2. Jashvant Poeran3 and
  3. Stavros G Memtsoudis2,4,5
  1. 1Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
  3. 3Orthopaedics/Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  4. 4Department of Anesthesiology, Weill Cornell Medicine, New York City, NY, USA
  5. 5Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
  1. Correspondence to Dr Alexander B Stone, Brigham and Women's Hospital, Boston, MA 02115, USA; abstone{at}partners.org

Abstract

Two recent, large-scale, randomized controlled trials comparing neuraxial anesthesia with general anesthesia for patients undergoing surgical fixation of a hip fracture have sparked interest in the comparison of general and neuraxial anesthesia. These studies both reported non-superiority between general and neuraxial anesthesia in this patient cohort, yet they have limitations, like their sample size and use of composite outcomes. We worry that that if there is a perception among surgeons, nurses, patients and anesthesiologists that general and spinal anesthesia are equivalent (which is not what the authors of the studies conclude), it may become difficult to argue for the resources and training to provide neuraxial anesthesia to this patient population. In this daring discourse, we argue that despite the recent trials, there remain benefits of neuraxial anesthesia for patients who have suffered hip fractures and that abandoning offering neuraxial anesthesia to these patients would be an error.

  • OUTCOMES
  • Methods
  • REGIONAL ANESTHESIA
  • Treatment Outcome
  • Outcome Assessment, Health Care

https://doi.org/10.1136/rapm-2022-104071

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    Footnotes

    • Twitter @alexbstone, @jashvant_p, @sgmemtsoudis

    • Contributors Study design/planning: all authors. Data analysis: all authors. Interpretation of results: all authors. Preparation of paper: all authors. Review of paper: all authors. Revision of manuscript: all authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests SGM has a US patent application for a Multicatheter Infusion System (US-2017-0361063) and is the owner of SGM Consulting. He is a partner in Parvizi Surgical Innovations. None of the aforementioned relations influenced the conduct of the present study. All other authors declare that they have no conflicts of interest.

    • Provenance and peer review Not commissioned; externally peer reviewed.