Spinal anesthesia tied to increased opioid use after hip surgery


Spinal anesthesia is increasingly being used instead of general anesthesia to improve patient comfort and reduce opioid use, but it could be having the opposite effect on hip fracture patients, according to research published June 13 in Annals of Internal Medicine.

"In our study, 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," said lead author Mark Neuman, MD, anesthesiologist and past-chair of the Penn Medicine Opioid Task Force, said. "While our study can't 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."

To confirm whether assumptions about spinal anesthesia and reduced pain were accurate, researchers at the University of Pennsylvania in Philadelphia examined 1,600 patients who underwent hip fracture surgery between 2016 and 2021. About half of enrollees had spinal anesthesia and the other half had general anesthesia, with each patient asked to assess their pain levels at varying intervals and outline their prescription painkiller use after surgery.

Overall, patients rated their worst pain the day after surgery. Spinal anesthesia patients indicated slightly higher levels of their worst pain, averaging 7.9 out of 10 compared to 7.6 among those who had general anesthesia, according to the study.

Spinal anesthesia patients were 33 percent more likely than general anesthesia patients to have taken prescription painkillers about two months after surgery, according to the study. No significant difference in prescription painkiller use was noted at six and 12 months after surgery, but researchers said the results are still reason to be wary.

"Even though the 180- and 365-day findings are not statistically significant, 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," Dr. Neuman said.

Researchers aim to conduct another study comparing the effects of spinal anesthesia and general anesthesia on total hip replacements.

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