Severe Pain After Hip Fracture Repair in Older Adults: Challenging a Dominant Narrative

EditorialsJuly 2022Severe Pain After Hip Fracture Repair in Older Adults: Challenging a Dominant NarrativeAlexander F. Arriaga, MD, MPH, ScD and Angela M. Bader, MD, MPHAlexander F. Arriaga, MD, MPH, ScDDepartment of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Center for Surgery and Public Health, and Ariadne Labs, Boston, Massachusetts and Angela M. Bader, MD, MPHDepartment of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, and Center for Surgery and Public Health, Boston, MassachusettsAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-1391 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Over a 3-month period, 2 multicenter randomized trials were published addressing the topic of neuraxial regional anesthesia versus general anesthesia for older adults undergoing hip fracture surgical repair (1, 2). Neither study showed superiority of one technique over the other for the primary and other key outcomes assessed. The REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) trial, a pragmatic randomized trial of patients aged 50 years or older at 46 U.S. and Canadian hospitals, found that spinal anesthesia was not superior to general anesthesia with respect to survival, recovery of ambulation at 60 days, or incidence ...References1. Neuman MD, Feng R, Carson JL, et al; REGAIN Investigators. Spinal anesthesia or general anesthesia for hip surgery in older adults. N Engl J Med. 2021;385:2025-2035. [PMID: 34623788] doi:10.1056/NEJMoa2113514 CrossrefMedlineGoogle Scholar2. Li T, Li J, Yuan L, et al; RAGA Study Investigators. Effect of regional vs general anesthesia on incidence of postoperative delirium in older patients undergoing hip fracture surgery: the RAGA randomized trial. JAMA. 2022;327:50-58. [PMID: 34928310] doi:10.1001/jama.2021.22647 CrossrefMedlineGoogle Scholar3. Neuman MD, Feng R, Ellenberg SS, et al. Pain, analgesic use, and patient satisfaction with spinal versus general anesthesia for hip fracture surgery. A randomized clinical trial. Ann Intern Med. 2022;175:952-60. doi:10.7326/M22-0320 LinkGoogle Scholar4. Danoff JR, Goel R, Sutton R, et al. How much pain is significant? Defining the minimal clinically important difference for the visual analog scale for pain after total joint arthroplasty. J Arthroplasty. 2018;33:S71-S75.e2. [PMID: 29567002] doi:10.1016/j.arth.2018.02.029 CrossrefMedlineGoogle Scholar5. Versyck B, Pawa A, Chin KJ. Minimal clinically important difference: a context-specific metric [Letter]. Reg Anesth Pain Med. 2021;46:933-934. [PMID: 33361313] doi:10.1136/rapm-2020-102330 CrossrefMedlineGoogle Scholar6. Harrison TG, Ronksley PE, James MT, et al. The Perioperative Surgical Home, Enhanced Recovery After Surgery and how integration of these models may improve care for medically complex patients. Can J Surg. 2021;64:E381-E390. [PMID: 34296705] doi:10.1503/cjs.002020 CrossrefMedlineGoogle Scholar7. Rathmell JP, Avidan MS. Patient-centered outcomes after general and spinal anesthesia [Editorial]. N Engl J Med. 2021;385:2088-2089. [PMID: 34818484] doi:10.1056/NEJMe2116017 CrossrefMedlineGoogle Scholar8. Bentov I, Rooke GA. Anesthesia for the older patient. In: Barash PG, Cullen BF, Stoelting RK, et al, eds. Clinical Anesthesia. 8th ed. Lippincott Williams & Wilkins; 2017:897-913. Google Scholar9. NYSORA–Education. Spinal or general anesthesia for hip fracture (NEJM). Accessed at https://youtu.be/D14Ch5yz8oI on 1 May 2022. Google Scholar10. Avidan MS, Whitlock EL, Mashour GA. General anesthesia and postoperative neurocognitive outcomes [Editorial]. JAMA. 2022;327:36-38. [PMID: 34928317] doi:10.1001/jama.2021.22465 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Center for Surgery and Public Health, and Ariadne Labs, Boston, MassachusettsDepartment of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, and Center for Surgery and Public Health, Boston, MassachusettsDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-1391.Corresponding Author: Alexander F. Arriaga, MD, MPH, ScD, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail, [email protected]harvard.edu.This article was published at Annals.org on 14 June 2022. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPain, Analgesic Use, and Patient Satisfaction With Spinal Versus General Anesthesia for Hip Fracture Surgery 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 Hassan , Trevor Stone , Steven Papp , Derek Donegan , Mitchell Marshall , J. Douglas Jaffe , Charles Luke , Balram Sharma , Syed Azim , Robert Hymes , Ki-Jinn Chin , Richard Sheppard , Barry Perlman , Joshua Sappenfield , Ellen Hauck , Mark A. Hoeft , Ann Tierney , Lakisha J. Gaskins , Annamarie D. Horan , Trina Brown , James Dattilo , Jeffrey L. Carson , and Metrics Cited byYear 2022 in review - Perioperative pain therapy July 2022Volume 175, Issue 7Page: 1039-1040KeywordsAnalgesicsAnesthesiaAnesthesiologyGeneral anesthesiaHip fracturesHospital medicineSurgery ePublished: 14 June 2022 Issue Published: July 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...