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

backgroundConcerns about the delayed diagnosis of acute compartment syndrome have led to recommendations favouring general anaesthesia over spinal anaesthesia in surgeries for diaphyseal tibia fractures. However, there is a lack of supporting clinical evidence. This study compared spinal anaesthesia and general anaesthesia in terms of compartment pressures, risk of acute compartment syndrome, and postoperative outcomes in tibia shaft fractures treated with intramedullary nailing.

methodsA randomized controlled study was carried out at a tertiary hospital from 2011 to 2021. Fifty patients with unilateral tibia shaft fractures were randomly assigned to receive either spinal or general anaesthesia. The primary outcome was compartment and delta pressures in the anterior tibial muscle compartment for 24 h after surgery. Secondary outcomes included near-infrared spectroscopy values, pain scores, and opioid consumption.

resultsDelta pressures were higher in the spinal anaesthesia group (estimated average effect over 24 h: 6.4 mmHg [CI 0.2-12.6]; p = 0.042). However, absolute compartment pressures were comparable between groups (effect estimate: -0.9 mmHg [CI -6.7 to 5.0]; p = 0.77). No cases of acute compartment syndrome occurred in the spinal anaesthesia group, while three patients treated with general anaesthesia required fasciotomy. There was no statistical difference in compartment surface oxygenation measured with near-infrared spectroscopy, pain scores, or median total opioid consumption between the study groups during the 24-h postoperative follow-up.

conclusionSpinal anaesthesia was not associated with higher compartment pressures compared to general anaesthesia. These findings suggest that prevailing concerns and recommendations about spinal anaesthesia for tibia shaft fracture surgery may need reconsideration and challenge recommendations favouring general anaesthesia as the primary method. EDITORIAL COMMENT: This study addresses whether or not spinal anaesthesia might affect acute compartment syndrome and outcomes in tibial shaft fractures. Despite small sample sizes, the findings suggest that spinal anaesthesia does not increase compartment pressures or delay diagnosis of acute compartment syndrome when patients are appropriately monitored. These results support spinal anaesthesia as a safe alternative in selected trauma patients in this context.

trial registrationClinicaltrials.gov identifier: NCT01795287.