Questions · Spinal versus General Anesthesia for Hip Fracture
8 questions, 0 approved. Approve them one at a time — a quiz shows nothing you have not.
Recall — derived from a kept point
In the REGAIN trial of spinal versus general anaesthesia for hip fracture surgery, name the composite outcome reported at 60 days, give the rate in each group, and state the trial's conclusion about superiority.
Answer: Death or inability to walk independently at 60 days occurred in 18.5% of spinal patients versus 18.0% of general anaesthesia patients, and delirium occurred in 20.5% versus 19.7%; spinal anaesthesia was not superior to general anaesthesia for hip fracture surgery.
REGAIN's rates sit close enough together that you cannot promise a family the spinal will keep her walking or keep her from becoming delirious.
Source claim: In REGAIN, spinal anaesthesia was not superior to general for hip fracture: death or inability to walk at 60 days occurred in 18.5% versus 18.0%, and delirium in 20.5% versus 19.7%.
Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults, The New England journal of medicine 2021
recall · CA-1 · phrased by llm
A patient with a hip fracture is waiting for surgery. What does the network meta-analysis evidence show about preoperative peripheral nerve blocks for pain at two hours, which block ranked best, and how confident is that evidence?
Answer: Preoperative peripheral nerve blocks reduce hip fracture pain at two hours; the pericapsular nerve group block outperformed femoral and fascia iliaca blocks, but most of the evidence supporting this was low confidence.
The two-hour analgesic benefit is worth acting on, but the ranking of the pericapsular nerve group block over femoral and fascia iliaca rests mostly on low-confidence evidence.
Source claim: Preoperative peripheral nerve blocks reduce hip fracture pain at two hours, and the pericapsular nerve group block outperformed femoral and fascia iliaca blocks, though most evidence was low confidence.
Peripheral Nerve Blocks in the Preoperative Management of Hip Fractures: A Systematic Review and Network Meta-Analysis, Annals of emergency medicine 2024
recall · CA-2 · phrased by llm
REGAIN included an analysis of pain and analgesic use. Describe how spinal anaesthesia compared with general anaesthesia for worst pain in the first 24 hours and for prescription analgesic use at 60 days, including the numbers.
Answer: Spinal anaesthesia gave slightly worse worst-pain scores in the first 24 hours and more prescription analgesic use at 60 days, 25% versus 18.8%, compared with general anaesthesia.
If anything the pain data run against spinal: slightly worse early worst pain, and more patients still on prescription analgesics at 60 days.
Source claim: REGAIN's pain analysis found spinal anaesthesia gave slightly worse worst-pain in the first 24 hours and more prescription analgesic use at 60 days (25% versus 18.8%) than general anaesthesia.
Pain, Analgesic Use, and Patient Satisfaction With Spinal Versus General Anesthesia for Hip Fracture Surgery : A Randomized Clinical Trial, Annals of internal medicine 2022
recall · CA-2 · phrased by llm
The surgical team asks you to tell a hip fracture patient that a spinal is the safer anaesthetic. Citing the randomised evidence, state how many patients have been randomised, which outcomes were compared, and what you can honestly tell the patient.
Answer: Two randomised trials totalling 2,550 patients compared mortality, delirium and ambulation and found no mortality benefit, no reduction in delirium and no better ambulation with spinal anaesthesia, so telling a patient that spinal is the safer choice is not supported by that evidence.
Two trials and 2,550 patients later, 'spinal is safer' is a claim the randomised data do not support — tell the patient these outcomes looked the same.
Source claim: Two randomised trials totalling 2,550 patients found no mortality benefit, no less delirium and no better ambulation with spinal anaesthesia, so telling a patient that spinal is the safer choice is not supported.
General Anesthesia Is an Acceptable Choice for Hip Fracture Surgery, Regional anesthesia and pain medicine 2023
recall · CA-3 · phrased by llm
The point with one number taken out. No model wrote any of this: the stem is the sentence you reviewed, minus a digit, and the paper it came from is named beneath it.
Open prompts
How does your plan change if the patient is not optimised?
open · CA-2 · phrased by derived
What is the physiology behind what we just did?
open · CA-2 · phrased by derived
Talk me through the trade-off you made there.
open · CA-2 · phrased by derived
What would make you abandon this plan and do something else?
open · CA-2 · phrased by derived
Questions only — nothing here asserts anything, which is why a model is allowed to phrase them. Where no model was reachable these are the level defaults.