Spinal anesthesia is not safer or more effective than general anesthesia in patients who undergo surgery for hip fractures, according to a major study.
The finding, which challenges the accepted view, offers doctors and patients better information in choosing the method that's best for them.
"The assumption of the anesthesia and surgical communities based on the literature up to the publication of this study was that if a patient could have spinal anesthesia it was probably the safer option," said co-author Derek Dillane, associate professor and acting chair of anesthesiology and pain medicine in the University of Alberta's Faculty of Medicine & Dentistry.
Those assumptions are being re-evaluated because they are based on older, smaller retrospective studies, which look back on patient records after surgery, Dillane said.
He and his colleagues conducted a prospective study, generally considered the most reliable method of research, in which they enrolled new patients, randomly assigned them to receive either general or spinal anesthesia, then monitored their outcomes. It's the largest clinical trial to date on the question, involving 1,600 patients aged 50 and older at 46 American and Canadian hospitals, including 151 patients at the University of Alberta Hospital. The results were published in the New England Journal of Medicine.
The team found no difference between the two types of anesthesia in the primary outcomes: death or an inability to walk three metres independently at two months following surgery. The incidence of post-operative delirium and length of hospital stay were also similar in both groups. The team reported slightly smaller risks with spinal anesthesia for dying during hospitalization, developing pneumonia or being admitted to intensive care.
"Spinal anesthesia for hip fracture surgery in older adults was not superior to general anesthesia with respect to survival and recovery of ambulation at 60 days," the researchers concluded.
