美国宾夕法尼亚大学佩雷尔曼医学院Mark D. Neuman团队比较了腰椎麻醉与全身麻醉对老年人髋部手术预后的影响。相关论文于2021年10月9日发表在《新英格兰医学杂志》上。
Title: Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults | NEJM
Author: Mark D. Neuman, M.D.,, Rui Feng, Ph.D.,, Jeffrey L. Carson, M.D.,, Lakisha J. Gaskins, M.H.S.,, Derek Dillane, M.D.,, Daniel I. Sessler, M.D.,, Frederick Sieber, M.D.,, Jay Magaziner, Ph.D., M.S.Hyg.,, Edward R. Marcantonio, M.D.,, Samir Mehta, M.D.,, Diane Menio, M.S.,, Sabry Ayad, M.D.,, Trevor Stone, M.D.,, Steven Papp, M.D.,, Eric S. Schwenk, M.D.,, Nabil Elkassabany, M.D.,, Mitchell Marshall, M.D.,, J. Douglas Jaffe, D.O.,, Charles Luke, M.D.,, Balram Sharma, M.D.,, Syed Azim, M.D.,, Robert A. Hymes, M.D.,, Ki-Jinn Chin, M.D.,, Richard Sheppard, M.D.,, Barry Perlman, M.D., Ph.D.,, Joshua Sappenfield, M.D.,, Ellen Hauck, D.O., Ph.D.,, Mark A. Hoeft, M.D.,, Mark Giska, M.D.,, Yatish Ranganath, M.D.,, Tiffany Tedore, M.D.,, Stephen Choi, M.D.,, Jinlei Li, M.D., Ph.D.,, M. Kwesi Kwofie, M.D.,, Antoun Nader, M.D.,, Robert D. Sanders, M.D.,, Brian F.S. Allen, M.D.,, Kamen Vlassakov, M.D.,, Stephen Kates, M.D.,, Lee A. Fleisher, M.D.,, James Dattilo, B.S.,, Ann Tierney, M.S.,, Alisa J. Stephens-Shields, Ph.D.,, and Susan S. Ellenberg, Ph.D.
The effects of spinal anesthesia as compared with general anesthesia on the ability to walk in older adults undergoing surgery for hip fracture have not been well studied.
We conducted a pragmatic, randomized superiority trial to evaluate spinal anesthesia as compared with general anesthesia in previously ambulatory patients 50 years of age or older who were undergoing surgery for hip fracture at 46 U.S. and Canadian hospitals. Patients were randomly assigned in a 1:1 ratio to receive spinal or general anesthesia. The primary outcome was a composite of death or an inability to walk approximately 10 ft (3 m) independently or with a walker or cane at 60 days after randomization. Secondary outcomes included death within 60 days, delirium, time to discharge, and ambulation at 60 days.
A total of 1600 patients were enrolled; 795 were assigned to receive spinal anesthesia and 805 to receive general anesthesia. The mean age was 78 years, and 67.0% of the patients were women. A total of 666 patients (83.8%) assigned to spinal anesthesia and 769 patients (95.5%) assigned to general anesthesia received their assigned anesthesia. Among patients in the modified intention-to-treat population for whom data were available, the composite primary outcome occurred in 132 of 712 patients (18.5%) in the spinal anesthesia group and 132 of 733 (18.0%) in the general anesthesia group (relative risk, 1.03; 95% confidence interval [CI], 0.84 to 1.27; P=0.83). An inability to walk independently at 60 days was reported in 104 of 684 patients (15.2%) and 101 of 702 patients (14.4%), respectively (relative risk, 1.06; 95% CI, 0.82 to 1.36), and death within 60 days occurred in 30 of 768 (3.9%) and 32 of 784 (4.1%), respectively (relative risk, 0.97; 95% CI, 0.59 to 1.57). Delirium occurred in 130 of 633 patients (20.5%) in the spinal anesthesia group and in 124 of 629 (19.7%) in the general anesthesia group (relative risk, 1.04; 95% CI, 0.84 to 1.30).
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 incidence of postoperative delirium was similar with the two types of anesthesia.