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Epidural analgesia for blunt thoracic injury--which patients benefit most?

AbstractINTRODUCTION:
Epidural analgesia for blunt thoracic injury has been demonstrated to be beneficial for pulmonary function, analgesia, and subjective pain; however the optimal patient selection and timing of thoracic epidural placement have not been well studied. We hypothesised that early (<48h) epidural analgesia (EA) as compared with usual care involving oral and intravenous narcotics delivered by patient-controlled analgesia (PCA) in patients with blunt thoracic trauma (>3 ribs fractured) is associated with fewer pulmonary complications and lower resource utilisation as measured by ICU and hospital length of stay.
METHODS:
This is a retrospective review of all non-intubated patients suffering from blunt thoracic injury with 3 or more rib fractures requiring hospital admission for >24h over a recent 5-year period. Pulmonary complications were defined as pneumonia, empyema, hypoxia, and need for delayed intubation. Logistic regression was utilised to analyse patient and injury characteristics associated with pulmonary complications.
RESULTS:
187 patients were included in the analysis; early thoracic epidural was utilised in 18% (n=34). There was no difference in age, ISS, ICU length of stay (LOS), or pulmonary complications between patients who received an epidural (EPI) compared with those who did not (NO EPI). A significantly increased incidence of pulmonary complications was noted in patients who required tube thoracostomy (p=0.017).
CONCLUSION:
In our experience, insertion of a thoracic epidural catheter early post-injury failed to reduce the incidence of pulmonary complications, ICU and hospital LOS. However, since pulmonary complications are more frequent in patients requiring tube thoracostomy, the cost-effectiveness of epidural analgesia in these patients warrants further investigation.
AuthorsDaniel Dante Yeh, Matthew E Kutcher, M Margaret Knudson, Julin F Tang
JournalInjury (Injury) Vol. 43 Issue 10 Pg. 1667-71 (Oct 2012) ISSN: 1879-0267 [Electronic] Netherlands
PMID22704784 (Publication Type: Journal Article)
CopyrightCopyright © 2012 Elsevier Ltd. All rights reserved.
Topics
  • Adult
  • Aged
  • Analgesia, Epidural (economics)
  • Analgesia, Patient-Controlled (economics)
  • Chest Tubes
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Intensive Care Units
  • Length of Stay
  • Male
  • Middle Aged
  • Pain (drug therapy)
  • Patient Selection
  • Retrospective Studies
  • Rib Fractures (drug therapy, physiopathology, rehabilitation)
  • Treatment Outcome
  • United States
  • Wounds, Nonpenetrating (drug therapy, physiopathology, rehabilitation)

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