SPINAL ANESTHESIA RULES FOR HIP FRACTURE!

This video serves as a crucial alert for all professionals and enthusiasts in the field of anesthesiology, especially those interested in the ongoing debate surrounding spinal versus general anesthesia for hip fracture surgery. Hosted on NYSORA's YouTube channel, the video features a detailed analysis of the REGAIN trial's findings, highlighting how misinterpretations and media oversimplification have potentially misled the public and healthcare professionals, risking patient safety and the integrity of education in regional anesthesia.

The narrative begins with a historical overview, noting that between 2012 and 2024, large retrospective trials consistently showed that spinal anesthesia reduces complications in patients undergoing hip fracture surgery. However, the REGAIN trial, published in the New England Journal of Medicine in 2021, controversially concluded that spinal anesthesia does not offer superior outcomes in terms of survival and recovery of ambulation at 60 days post-surgery compared to general anesthesia. This conclusion was drawn despite the trial's limitations, such as its focus on healthier patients and the lack of a standardized protocol for spinal anesthesia, which resulted in a 15% failure rate necessitating a switch to general anesthesia.

Further complicating the issue, subsequent publications from the REGAIN investigators presented mixed findings on pain and analgesic use post-surgery, with the latest slice of the study in 2024 suggesting similar long-term outcomes between spinal and general anesthesia. These publications have sparked concerns over the potential negative impact on the choice of anesthesia for frail patients and the training of future anesthesiologists in regional anesthesia techniques.

The video emphasizes the importance of scrutinizing the REGAIN trial's methodology and conclusions, arguing that misinterpretations could lead to misguided clinical practices and educational standards. It calls for a reevaluation of the evidence and stresses the need for a balanced understanding of anesthesia options to ensure patient safety and the advancement of regional anesthesia.

In a bid to counteract the spread of misinformation, the video also addresses the REGAIN investigators' recent grant application aimed at developing educational tools that could further influence patient and practitioner perspectives on spinal anesthesia. The presenter, while expressing respect for the REGAIN team's work, urges the anesthesiology community to critically assess the trial's findings and their implications for clinical practice and education.

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[wvsteadman]

When I took over as director at a regional hospital in WV, they were doing all general anesthesia for total hips and hip fractures. A very busy practice with hundreds of total joints per month, they had several heart attacks and strokes per month in that patient population. After I instituted spinals as the preferred method (general only if patient refused or it couldn't be accomplished), we dropped to less than 5 MACE per year and no deaths. When I read the REGAIN article, I considered writing a letter to the editor, but since I am no longer an academic, I assumed it would not be published.

[DocSavage-wk]

Knowledge is constantly advancing; today's truth is tomorrow's lie.

[dr.vineetrai]

I'm shocked and literally laughing on this report ...

I'm from India working in a small city with limited resources in hospitals and I can tell you that from my 15yrs of practice ...

Spinal anaesthesia is the safest of them all !!
How can be a cocktail of sedative, analgesic, muscle relaxant, inhalational gases and forced respiration be safer in an elderly patient of hip surgery than a spinal ??...this is a ridiculous & bizarre research report !


This team should do their research in countries where anesthesiologist are working with limited access to facilities and will be shocked to see the effectiveness of SA over GA

[zakalobi]

Where I work, spinal anesthesia is the first choice for those patients population. GA is limited for very selected patients with clear contraindications for SA.

[marcoantoniodiaz]

En mi práctica profesional, siempre que se pueda la anestesia espinal es la técnica de elección por encima de la anestesia general...de hecho mi tesis(2018) fue de este mismo tema y aunque no fue publicada por una revista prestigiosa, las conclusiones alcanzados fueron que con la anestesia espinal hubo un menor de complicaciones peri-operatorias, mejor analgesia postoperatoria y una disminución en la estadia hospitalaria que con la anestesia general en la cual existió un pobre control del dolor y aumento en la estadia hospitalaria

[BruceLeigh-euwm]

I am recovering from hip replacement surgery. I had spinal anesthesia. I was up walking in the hallway without pain using walker about 5 hours later. Went home about an hour after that. I had the other hip done 10 years ago with general. Spent 3 days in the hospital, had unexplained fevers, terrible pain the whole time post op. This time was a piece of cake compared to the first time. (same surgeon)

[fantasticdvdarab]

With all due respect boss, although I would still go for regional myself, but the study is pretty solid. Majority of the patients included (66%) were ASA lll or lV. Most were older that 65 yrs. And they didn't say that the 15% conversion was due to failure of spinal. In fact, 8% of the assigned general anesthesia group recieved spinal. I personally agree with your openion, and would recommend it to my patients if they asked me, but such evidence shouldn't be dismissed based on openion.

[stephanerasmus]

Oh my… both modalities have pros and cons. If I failed at 15% of my spinals I would prefer GA as well 😂

[bobmillwee]

In 30 years of doing these cases, the spinal patients do markedly better. Besides that, the patient families have a strong preference to give as little sensorium-altering medication as possible. I don’t care what this ridiculous study purports to demonstrate- my experience supersedes it-especially when a family wants minimal anesthesia for their family member. I guess when the family is upset about their confused mother we are supposed to say “Studies show it makes no difference “. That is horse-s. This study just makes excuses for the anesthesia providers that suck at regional anesthesia and do GA, rather than master a technique that in reality does make a difference.

[peterzimmermann]

personal opinion meets scientific evidence 😡💔