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 (<48 h) 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 >24 h 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.
Keywords
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Article info
Publication history
Accepted:
May 22,
2012
Identification
Copyright
© 2012 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
