Epidural analgesia for blunt thoracic injury - Which patients benefit most?

Daniel Dante Yeh, Matthew E. Kutcher, M. Margaret Knudson, Julin F. Tang

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1667-1671
Number of pages5
JournalInjury
Volume43
Issue number10
DOIs
StatePublished - Oct 2012
Externally publishedYes

Keywords

  • Blunt thoracic injury
  • Epidural analgesia
  • Rib fractures

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

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