Epidural analgesia for traumatic rib fractures is associated with worse outcomes: a matched analysis

McKendy, Katherine M.; Lee, Lawrence F.; Boulva, Kerianne; Deckelbaum, Dan; Mulder, David S.; Razek, Tarek; Grushka, Jeremy

doi:10.1016/j.jss.2017.02.057

Cited by 41 publications

(24 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, they remarked that the feasibility of this analgesic modality is limited by numerous contraindications. In contrast, a recent matched-cohort study of McKendy et al showed that patients with one or more fractured ribs who received epidural analgesia were associated with higher rates of respiratory complications and an increased hospital length of stay compared to patients who received other analgesic interventions [19]. They stated that possible explanations for a failed application of epidural analgesia were lack of experience with the use of epidural analgesia and inability of early mobilization.…”

Section: Discussionmentioning

confidence: 99%

“…Over the past decades, several studies reported on beneficial outcomes of epidural analgesia and encouraged the use of epidural analgesia over other analgesic modalities [1, 6, 10–16]. However, there is growing evidence questioning its advantages over other analgesic modalities in the management of severely injured trauma patients [4, 17–19]. Furthermore, the current evidence is of low quality, and therefore, the recommendation of the EAST is conditional [9].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Epidural Analgesia for Severe Chest Trauma: An Analysis of Current Practice on the Efficacy and Safety

Peek

Beks

Kingma

et al. 2019

Critical Care Research and Practice

View full text Add to dashboard Cite

Background. Adequate pain control is essential in the treatment of patients with traumatic rib fractures. Although epidural analgesia is recommended in international guidelines, the use remains debatable and is not undisputed. The aim of this study was to describe the efficacy and safety of epidural analgesia in patients with multiple traumatic rib fractures. Methods. A retrospective cohort study was performed. Patients with ≥3 rib fractures following blunt chest trauma who received epidural analgesia between January 2015 and January 2018 were included. The main outcome parameters were the success rate of epidural analgesia and the incidence of medication-related side effects and catheter-related complications. Results. A total of 76 patients were included. Epidural analgesia was successful in a total of 45 patients (59%), including 22 patients without and in 23 patients with an additional analgesic intervention. In 14 patients (18%), epidural analgesia was terminated early without intervention due to insufficient sensory blockade (n=4), medication-related side effects (n=4), and catheter-related complications (n=6). In 17 patients (22%), the epidural catheter was removed after one or multiple additional interventions due to insufficient pain control. Minor epidural-related complications or side effects were encountered in 36 patients (47%). One patient had a major complication (opioid intoxication). Conclusion. Epidural analgesia was successful in 59% of patients; however, 30% needed additional analgesic interventions. As about half of the patients had epidural-related complications, it remains debatable whether epidural analgesia is a sufficient treatment modality in patients with multiple rib fractures.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Epidural Analgesia for Severe Chest Trauma: An Analysis of Current Practice on the Efficacy and Safety

Peek

Beks

Kingma

et al. 2019

Critical Care Research and Practice

View full text Add to dashboard Cite

show abstract

“…In blunt chest trauma with rib fractures, epidural block remains the most commonly used technique, but its achievements could be technically difficult in trauma care, and its use is becoming increasingly controversial . In fact, sympathetic blockade and its hemodynamic consequences induced by epidural blockade remain problematic in trauma care.…”

Section: Discussionmentioning

confidence: 99%

Serratus Plane Block Is Effective for Pain Control in Patients With Blunt Chest Trauma: A Case Series

et al. 2019

View full text Add to dashboard Cite

Background Rib fractures occur frequently following blunt chest trauma and induce morbidity and mortality. Analgesia is a cornerstone for their management, and regional analgesia is one of the tools available to reach this objective. Epidural and paravertebral blocks are the classical techniques used, but the serratus plane block (SPB) has recently been described as an effective technique for thoracic analgesia. Methods This case series reported and analyzed 10 consecutive cases of SPB for blunt chest trauma analgesia in a level 1 trauma center from May to October 2018. SPB was performed with either a single shot of local anesthetic or a catheter infusion. Results Ten patients were treated with 3 single shots and 7 catheter infusions (median length 3 days [interquartile range (IQR) 2.5 to 3.5]). The Median Injury Severity Score was 16 (IQR 16 to 23), and the number of broken ribs ranged from 3 to 22. Daily equivalent oral morphine consumption was significantly decreased after SPB from 108 mg (IQR 67 to 120) to 19 mg (IQR 0 to 58) (P = 0.015). The Numeric Pain Rating Scale (NPRS) score during cough was significantly decreased from 7.3 (IQR 5.3 to 8.8) to 4 (IQR 3.6 to 4.6) (P = 0.03). The NPRS score at rest remained unchanged. One complication occurred, due to a catheter section. Conclusions The SPB technique (with or without catheter insertion) in 10 patients who had blunt chest trauma with rib fractures is effective for cough pain control, with a significant decrease in morphine consumption.

show abstract

“…Objective evidence of pulmonary function based on incentive spirometry volumes, oxygenation and pain control is followed and surgical fixation is offered to patients who fail any of those measures. Data continues to emerge evaluating multimodality pain control for the management of chest wall injuries, and it is unclear that pain control alone is associated with favorable outcomes as there are mixed results with some studies suggestive benefits of multimodality pain regimens, and others showing no benefit [8][9][10][11]. The expansion of surgical repair beyond the traditional indications including flail chest, perhaps enriches the protocol based outcomes, particularly with the use of muscle sparing smaller incisions.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2018

Trauma Cases Rev

View full text Add to dashboard Cite

Introduction: Non-operative management of rib fractures can lead to significant morbidity such as chronic pain, and dyspnea. Up to 40% may also fail to return to work. Over the last decade rib fixation has made resurgence and there are emerging data supporting early fixation in patients that fail aggressive pain control even in non-flail segments. We describe our early experience with early rib fixation in a small cohort of patients with severe chest wall injury.

show abstract

Epidural analgesia for traumatic rib fractures is associated with worse outcomes: a matched analysis

Cited by 41 publications

References 29 publications

Epidural Analgesia for Severe Chest Trauma: An Analysis of Current Practice on the Efficacy and Safety

Epidural Analgesia for Severe Chest Trauma: An Analysis of Current Practice on the Efficacy and Safety

Serratus Plane Block Is Effective for Pain Control in Patients With Blunt Chest Trauma: A Case Series

Untitled

Contact Info

Product

Resources

About