To evaluate the efficacy of
opiate administration regimens, 32 patients with multiple
rib fractures were prospectively randomized to receive either continuous epidural (ED) or continuous intravenous (IV) infusions of
fentanyl. Dosage was titrated to individual subjective
pain relief. Ventilatory function tests (VFTs), arterial blood
gases (ABGs), and visual analog scores were obtained before and after the institution of
analgesia. Post-
analgesia values were compared with pre-
analgesia values using a two-tailed paired t-test looking for significant changes produced by the
analgesic method. Both methods significantly improved analog
pain scores. The ED method produced improvement in both maximum inspiratory pressure (MIP) and vital capacity (VC), whereas IV
analgesia only produced improvement in VC. Intravenous
fentanyl produced increases in PaCO2 and decreases in PaO2, whereas no significant changes in ABGs were observed with ED
fentanyl administration. Side effects were similar between the groups, with
pruritus being more pronounced with ED
fentanyl administration. The data demonstrate that the continuous ED
fentanyl method offers excellent relief of
pain and improvement in ventilatory function and has distinct advantages over IV
fentanyl administration with respect to changes in ABGs and MIP. The continuous infusion of epidural
opiates should be the preferred
analgesic method for patients at high risk of developing pulmonary complications following multiple
rib fractures.