REGAIN study

• Large multicenter RCT of 1600 patients comparing spinal anaesthesia with general anaesthesia for patients 50 years or older undergoing hip fracture surgery

• Primary outcome is composite of death of inability to walk independently or with a walker or cane at 60 days after randomisation.

• They found that spinal anaesthesia was not superior to general anaesthesia with regards to survival and recovery of ambulation at 60 days.

• no difference in incidence of post-operative delirium.

POISE III

• This is a large multinational RCT involving 9535 patients looking at Tranexamic acid (TXA) in patients undergoing non-cardiac surgery.

• Inclusion criteria are patients who met criteria for increased risk of bleeding and cardiovascular events.

• TXA protocol include:

  • Two IV doses of 1g TXA as a bolus or 10 min infusion at beginning of surgery and at wound closure.

• Findings:

  • They found significantly lower incidence of composite bleeding outcome (life threatening bleeding, major bleeding and bleeding into a critical organ) at 30 days with TXA compared with placebo.

  • TXA reduced relative risk of bleeding by approximately 25% (consistent across all types of noncardiac surgery)

  • Non-inferiority was not established for the primary safety outcome. I.e physicians will have to weigh the benefits of 2.6% reduction in absolute difference in bleeding vs 0.3% increased in incidence of composite cardiovascular outcomes.

• Other notes:

  • trial was stopped early due to financial deficit secondary to COVID pandemic but was able to enroll more than 95% of original planned sample size.

• Conclusion:

  • In patients with high risk bleeding, TXA reduces risk of bleeding and appears to be safe.

  • This study may support the routine use of TXA in patients at risk of bleeding, with the subsequent benefit of conservation of blood products.

PADDI Trial

• Published recently at NEJM, the large multicenter PADDI trial showed that "Dexamethasone was noninferior to placebo with respect to the incidence of surgical-site infection within 30 days after nonurgent, noncardiac surgery".

BALANCED Anaesthesia Study

• Recently published at The Lancet, the BALANCED study looks at the association between anaesthetic depth and 1-year mortality in older patients having major surgery.

• It is a multi-national RCT involving 6644 patients.

• They found light general anaesthesia (BIS target 50) to not be associated with lower 1-year mortality than deep general anaesthesia (BIS target 35).

CRASH-3 Trial

• Recently published at The Lancet, CRASH-3 trial is a randomised, placebo-controlled trial that looks at the effects of tranexamic acid (TXA) on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury. It is a large multi-centre RCT involving 12737 patients from 29 countries.

• This build upon current knowledge, including the results from CRASH-2 which shows mortality benefit with TXA administration in trauma patients.

• This study showed that the risk of death from head injury was reduced in patients treated with TXA (absolute reduction of 1.7%). No evidence of increase in disability among survivors were found, no increased risk of vascular occlusive events were found.

• Patients with GCS 3 or bilateral non-reactive pupils were excluded.

• Good summary found here.