Effect of epidural analgesia in patients with traumatic rib fractures: a systematic review and meta-analysis of randomized controlled trials.
Abstract | PURPOSE: A consensus group recently proposed epidural analgesia as the optimal analgesic modality for patients with multiple traumatic rib fractures. However, its beneficial effects are not consistently recognized in the literature. We performed a systematic review and a meta-analysis of randomized controlled trials (RCT) of epidural analgesia in adult patients with traumatic rib fractures. METHODS: A systematic search strategy was applied to MEDLINE, EMBASE, the Cochrane Library and to the annual meeting of relevant societies (up to July 2008). All randomized controlled trials comparing epidural analgesia with other analgesic modalities in adult patients with traumatic rib fractures were included. Primary outcomes were mortality, ICU length of stay (LOS), hospital LOS and duration of mechanical ventilation. RESULTS: Eight studies (232 patients) met eligibility criteria. Epidural analgesia did not significantly affect mortality (odds ratio [OR] 1.6, 95% CI, 0.3, 9.3, 3 studies, n = 89), ICU LOS (weighted mean difference [WMD] -3.7 days, 95% CI, -11.4, 4.0, 4 studies, n = 135), hospital LOS (WMD -6.7, 95% CI, -19.8, 6.4, 4 studies, n = 140) or duration of mechanical ventilation (WMD -7.5, 95% CI, -16.3, 1.2, 3 studies, n = 101). Duration of mechanical ventilation was decreased when only studies using thoracic epidural analgesia with local anesthetics were evaluated (WMD -4.2, 95% CI, -5.5, -2.9, 2 studies, n = 73). However, hypotension was significantly associated with the use of thoracic epidural analgesia with local anesthetics (OR 13.76, 95% CI, 2.89, 65.51, 3 studies, n = 99). CONCLUSIONS:
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Authors | François M Carrier, Alexis F Turgeon, Pierre C Nicole, Claude A Trépanier, Dean A Fergusson, Daniel Thauvette, Martin R Lessard |
Journal | Canadian journal of anaesthesia = Journal canadien d'anesthesie
(Can J Anaesth)
Vol. 56
Issue 3
Pg. 230-42
(Mar 2009)
ISSN: 0832-610X [Print] United States |
PMID | 19247744
(Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
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Topics |
- Adult
- Analgesia, Epidural
(adverse effects)
- Data Interpretation, Statistical
- Humans
- Intensive Care Units
- Length of Stay
- Pain
(drug therapy, etiology)
- Publication Bias
- Randomized Controlled Trials as Topic
- Reproducibility of Results
- Respiration, Artificial
- Respiratory Mechanics
(physiology)
- Rib Fractures
(complications, etiology, mortality)
- Treatment Outcome
- Wounds and Injuries
(complications)
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