Once again, the findings of a new study contradicted a generally held belief in the medical community.

As a way to provide more comfort to patients and reduce painkiller use, spinal anesthesia is increasingly being utilized instead of general anesthesia for specific surgeries.

However, research among hip fracture patients suggests that this adjustment may be having the opposite impact than anticipated.

The study was published today in Annals of Internal Medicine by researchers from the University of Pennsylvania’s Perelman School of Medicine.

Study lead author Mark Neuman says that in the study, they found “patients who got spinal anesthesia did get fewer opioids in the operating room, but they ended up having more pain, and more prescription pain medication use after surgery.” 

While this new study can not “determine conclusively whether this was due to the spinal anesthesia itself or the fact that fewer opioids were given up front, this is a result that should make people examine some of the assumptions informing current care pathways,” adds the author.

Neuman and his colleagues wanted to see if their theories about spinal anesthesia and pain relief were correct. So they looked at data from 1,600 individuals who had hip fracture surgery at dozens of institutions across the United States and Canada between 2016 and 2021.

The REGAIN Trial enrolled about half of the participants, who got spinal anesthesia for their surgery and the other half had general anesthesia.

Each patient was asked to rate their discomfort on a scale of 1 to 10 at various intervals, as well as identify whether or not they used prescription painkillers after the treatment.

Overall, patients assessed their worst pain the day after their surgery, with spinal anesthesia patients reporting somewhat higher levels of worst pain, average 7.9 out of 10 against 7.6 for general anesthetic patients.

Then, two months after their treatment, spinal anesthesia patients were 33 percent more likely than general anesthetic patients to continue taking prescription medications. At six and twelve months after surgery, there was no discernible change in prescription pain medication use, but Neuman remained skeptical of what he saw.

“Even though the 180- and 365-day findings are not statistically significant,” Neuman adds, “the 60-day finding is still concerning, since there could be medication-related harms like respiratory depression or over-sedation that could still occur over the short term.”

The study follows Neuman’s research from 2021, which found that general anesthesia was just as safe for patients with shattered hips as spinal anesthesia. The outcomes of that study, once again, contradicted a generally held belief in the medical community.

Neuman and his colleagues hope to improve pain management for patients with hip fractures and dementia by figuring out how to increase the use of peripheral nerve blocks, a type of local anesthetic injection that is still underutilized despite recommendations that it be used in all hip fracture patients.

They also intend to apply the same lens to complete joint replacements, such as hip replacements, as they used in the REGAIN experiment, which compared general versus spinal anesthesia.

Image Credit: Getty

You were reading: Most Commonly Used Anesthesia Could Make You Take More Painkillers