Abstract | INTRODUCTION:
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.
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Authors | Daniel Dante Yeh, Matthew E Kutcher, M Margaret Knudson, Julin F Tang |
Journal | Injury
(Injury)
Vol. 43
Issue 10
Pg. 1667-71
(Oct 2012)
ISSN: 1879-0267 [Electronic] Netherlands |
PMID | 22704784
(Publication Type: Journal Article)
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Copyright | Copyright © 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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