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General anesthesia is as effective and may be better than long-acting spinal anesthesia

More than 250,000 elderly men and women in the United States will fracture a hip during the coming year. One-third of them will die within a year after their fractures, and most will suffer from impaired mobility and independence. Doctors usually prefer "safer" spinal anesthesia over general anesthesia to repair hip fractures. However, a new study of elderly hip fracture patients showed similar outcomes for both types of anesthesia. What's more, it found that patients receiving general anesthesia had better cognitive functioning and walking ability up to 24 months after surgery than those who received long-acting spinal anesthesia.

Researchers at the University of Maryland School of Medicine studied 741 elderly patients who were enrolled in the Baltimore Hip Studies, a multicenter, noninterventional observational research project investigating long-term recovery from hip fracture. Patients enrolled in the study were given either spinal anesthesia (430 patients using lidocaine, bupivacaine, or tetracaine) or general anesthesia (311 patients using induction agents, benzodiazepines, narcotics, and other medications) for hip fracture repair. The researchers evaluated the patients' progress at 2, 6, 12, 18, and 24 months after surgery with a portable gait and balance laboratory. There were no significant differences for in-hospital complications or deaths either by route of anesthesia or the type of hospital (academic or community) where the surgery was done.

There was no significant difference in outcomes 2 years after surgery between the two types of anesthesia. The general anesthesia group did show a 43 percent reduction in the odds of impaired ability to walk 10 feet a year after surgery, as well as nonsignificant trends toward better social interaction and cognitive functioning. Of the three spinal anesthetics (i.e., epinephrine, lidocaine, and tetracaine) there was little difference between lidocaine and general anesthesia. However, general anesthesia was associated with slightly better outcomes than was either tetracaine or bupivacaine, which are longer acting drugs than lidocaine. This suggests that longer acting, but lower concentration, local anesthetics might be associated with subtle neurologic injury. On the other hand, lidocaine may have been selected for shorter, less complicated surgeries, which was reflected in better outcomes.

More details are in "Spinal anesthesia versus general anesthesia for hip fracture repair: A longitudinal observation of 741 elderly patients during 2-year follow-up," by Timothy B. Gilbert, M.D., William G. Hawkes, Ph.D., Richard Hebel, Ph.D., and others, in the January 2000 American Journal of Orthopedics 29(1), pp. 25-35.

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