Society of university surgeonsEpidural analgesia improves outcome after multiple rib fractures☆
Section snippets
Methods
All patients admitted to our Level 1 trauma center who were older than 18 years and had 3 or more rib fractures were screened for enrollment from March 1, 2000, through December 15, 2003. Patients who had chest wall pain requiring IV opioids were evaluated for eligibility to receive thoracic epidural analgesia. Patients were excluded if they had any acute spine fracture or pre-existing spine deformity, severe traumatic brain or spinal cord injury, or severe altered mental status such that pain
Results
During the study period, 408 patients who were older than 18 years and had more than 3 rib fractures were admitted. Of these, 282 were excluded, 80 refused participation or could not be consented, and 46 were enrolled (Figure). Twenty-two patients were randomized to the epidural group and 24 to the systemic opioid group. The groups were comparable for gender, mean age, mean ISS score, chest Abbreviated Injury Scale (AIS), head AIS, hypotension on admission, and mean number of ribs fractured (
Discussion
Previous studies have demonstrated that epidural analgesia after rib fractures is associated with improved pain relief scores and improved pulmonary function tests compared to IV opioids.4., 5. These studies have not, however, identified a definitive association between these factors and improved patient outcome. Retrospective reviews of epidural versus opioid administration are hampered by significant selection bias because patients who receive epidural catheters tend to be older and have more
Conclusion
We demonstrated that epidural analgesia, when feasible, improves the outcome for patients with chest wall pain associated with multiple rib fractures. Use of this therapy is limited by associated injuries in this patient population.
References (9)
- et al.
The morbidity and mortality of rib fractures
J Trauma
(1994) - et al.
Three or more rib fractures as an indicator for transfer to a Level I trauma center: a population-based study
J Trauma
(1990) - et al.
Rib fractures in the elderly
J Trauma
(2000) - et al.
Prospective evaluation of epidural and IV administration of fentanyl for pain control and restoration of ventilatory function following multiple rib fractures
J Trauma
(1991)
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Presented at the 65th Annual Meeting of the Society of University Surgeons, St. Louis, Missouri, February 11-14, 2004.