Spinal Anaesthesia Versus General Anaesthesia for Patients With Tibia Shaft Fractures-A Randomized Controlled Study.

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Trauma Care

Background:

• Concerns exist regarding delayed acute compartment syndrome (ACS) diagnosis with spinal anaesthesia for diaphyseal tibia fractures.
• Current recommendations often favor general anaesthesia (GA) despite limited clinical evidence.
• This study aimed to compare spinal anaesthesia (SA) and GA in managing tibia shaft fractures.

Purpose of the Study:

• To compare compartment pressures and the risk of acute compartment syndrome (ACS) between spinal anaesthesia (SA) and general anaesthesia (GA).
• To evaluate postoperative outcomes, including pain and opioid consumption, in patients undergoing intramedullary nailing for tibia shaft fractures under SA versus GA.

Main Methods:

• A randomized controlled trial involving 50 patients with tibia shaft fractures.
• Patients were assigned to receive either spinal anaesthesia (SA) or general anaesthesia (GA).
• Primary outcome: anterior tibial compartment pressures and delta pressures for 24 hours post-surgery; Secondary outcomes: near-infrared spectroscopy, pain scores, opioid consumption.

Main Results:

• Higher delta pressures were observed with SA, but absolute compartment pressures were comparable between SA and GA groups.
• No cases of ACS occurred in the SA group; three patients in the GA group required fasciotomy.
• No significant differences were found in compartment oxygenation, pain scores, or opioid consumption between the groups.

Conclusions:

• Spinal anaesthesia (SA) is not associated with increased compartment pressures compared to general anaesthesia (GA) in tibia shaft fracture surgery.
• Findings challenge current recommendations favoring GA, suggesting SA is a safe alternative when appropriately monitored.
• The study supports reconsidering SA as a viable option for selected trauma patients undergoing tibia fracture repair.