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

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 SharmaSyed 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

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


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. ( 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.

Original languageEnglish (US)
Pages (from-to)952-960
Number of pages9
JournalAnnals of internal medicine
Issue number7
StatePublished - Jul 2022

All Science Journal Classification (ASJC) codes

  • Internal Medicine


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