Thoracic Epidural Analgesia versus Intravenous Patient-Controlled Analgesia for the Treatment of Rib Fracture Pain after Motor Vehicle Crash

Abstract

Thoracic epidural analgesia with bupivacaine and fentanyl provided superior analgesia than intravenous patient-controlled analgesia morphine.

L’effet de l’analgésie péridurale chez les patients présentant des fractures de côtes multiples: une revue systématique et une méta-analyse des essais randomisés contrôlés

“…5,7 Multiple analgesic modalities have been used in patients with rib fractures, 4 such as oral analgesics, 10 intravenous opioids, 7,11 patient-controlled opioid analgesia, 12 interpleural blocks, 11 intercostal blocks, 11,13 paravertebral blocks, 11,14 and epidural analgesia. 6,7,10,11,15,16 Recent studies and metaanalyses have suggested that epidural analgesia reduces morbidity after major abdominal, [17][18][19][20] vascular, 18,20,21 and thoracic surgeries, 17,18,20 overcoming the potential risk of complications associated with this technique. 4,[18][19][20][21][22][23][24] In trauma patients with rib fractures, retrospective studies showed inconsistent benefits of epidural analgesia compared to other analgesic modalities.…”

“…4,[18][19][20][21][22][23][24] In trauma patients with rib fractures, retrospective studies showed inconsistent benefits of epidural analgesia compared to other analgesic modalities. 4,6,10,15,16 The conclusion of a recent narrative review on pain management in this population stated that, based on available data, no single analgesic modality could be recommended. 11 However, recent published guidelines state that epidural analgesia is the preferred analgesic modality in patients with multiple rib fractures.…”

Bony injuries in trauma patients diagnosed by radiological examination

“…In one study, the use of thoracic epidural provided better analgesia than patient controlled analgesia. 12 These methods of pain relief are currently not available in most hospitals.…”

Traumatic flail chest injuries and the benefits of epidural analgesia

“…While the effects of PCA and oral pain medications are well studied [14], conclusions on the benefits derived from epidural analgesia are inconsistent [15]. Studies in the past have demonstrated that epidural analgesia provides superior pain relief and improves pulmonary function tests when compared to intravenous opioids for patients with rib fractures [14,16,17]. In 2004, Bulger, et al concluded that epidural analgesia is associated with a decrease in the rate of nosocomial pneumonia and a shorter duration of mechanical ventilation after rib fractures [18], and in 2014, Gage, et al concluded that epidural catheter placement was associated with a significantly decreased risk of mortality in patients with blunt thoracic injury with three or more rib fractures [15].…”