The morbidity and mortality associated with blunt thoracic
trauma are significant and can be multisystem in nature. Of these, pulmonary complications, including ventilatory impairment secondary to
pain, have been recognized to be the most consequential. Although several
analgesic strategies have emerged, thoracic
epidural analgesia (
TEA) has arguably demonstrated superior efficacy and is used frequently in adults. Unfortunately,
TEA is rarely used in children after blunt thoracic
trauma, but may be of considerable benefit. This low rate of use likely reflects one or more of several factors potentially encountered when considering the use of
TEA in pediatric chest wall
trauma. Among them are (1) uncertainty regarding safety and efficacy; (2) the technical challenges of pediatric thoracic epidural placement, including technique and equipment concerns; and (3)
drug selection, dosing, and toxicity. The following case review describes the successful application of
TEA in a 4-year-old boy after multiple traumatic
rib fractures and associated
pneumothorax and pulmonary
contusion.