Episode 16: Daring Discourse, Spinal Anesthesia vs General Anesthesia for Hip Fracture Patients

In November of 2021, the Regional versus General Anesthesia for Promoting Independence after Hip Fracture (REGAIN) trial was published in the New England Journal of Medicine. This study was a pragmatic randomized superiority trial to evaluate spinal anesthesia as compared with general anesthesia in 1,600 patients. The authors concluded that “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.” In this month’s RAPM Focus, Editor-in-Chief Brian Sites, MD, covers both angles of this story in a daring discourse with Alexander Stone, MD, lead author of “There remains a role for neuraxial anesthesia for hip fracture surgery in the post-REGAIN era,” published March 2023 (https://rapm.bmj.com/content/early/2023/03/27/rapm-2022-104071), and Eric Schwenk, MD, lead author of “General anesthesia is an acceptable choice for hip fracture surgery,” also published March 2023 (https://rapm.bmj.com/content/early/2023/03/27/rapm-2023-104454). Dr. Alexander Stone is an anesthesiologist at Brigham and Women’s Hospital, and an assistant professor at Harvard Medical School. He completed his medical school at Johns Hopkins and his residency training at Brigham and Women’s. He went on to complete a regional anesthesia and acute pain fellowship at Hospital for Special Surgery, before returning to Brigham as a faculty member. His research interests include expanding access to regional anesthesia through enhanced recovery program implementation, as well as collaborating with other specialties. Dr. Eric Schwenk completed a fellowship in regional anesthesia and acute pain at Thomas Jefferson University Hospital in 2013 and has remained on staff as a faculty member. His research interests center on ketamine for migraine, perioperative ketamine, outcomes after orthopedic surgery, and challenging long-held dogmas in medicine. He has been an active speaker for ASRA Pain Medicine, is on the Regional Anesthesia & Pain Medicine editorial board, and is a co-author of the REGAIN study. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.