According to our results, permanent epidural anaesthesia was significantly superior to systemic
opioid treatment in patients with serial
rib fractures. The main advantages were not only continuous
pain relief despite the fact that the nonepidural control group required more than twice the dosage of
morphine derivatives; also, the respiratory and
pain-related recovery time was reduced. Another advantage was the selective effect (due to the local application) on respiratory
pain and therefore on respiration as a whole. Deep breathing and expectoration were easier, so that the use of
respirators and other artificial breathing
aids could be avoided or at least reduced in duration in some cases. This makes the method particularly suitable for use in the management of polytraumatized patients. The standard dose was a mixture of 3.3 mg
morphine and 37.5 mg
bupivacaine (= 1/3 ampoule
morphine + 15 ml
Carbostesin 0.25%) every 12 h. When
morphine was temporary contraindicated (frequently the final diagnosis in the case of an "
acute abdomen" delayed the administration of
morphine) the use of
bupivacaine alone provided a satisfactory result for a certain time (we never observed tachyphylaxis). Additional systemic
pain relievers were only necessary when the patient was suffering from
pain caused by other
injuries beyond the area of effectiveness of the epidural
catheter (the only obvious disadvantage of the local application technique). On the other hand, epidural anaesthesia enabled us to treat a patient's lower-leg fracture by interlocking nailing, while adding only 0.01 mg
fentanyl (= 2 ml
Fentanyl Janssen) and 1.2 mg
flunitrazepam (
Rohypnol).