Thoracic Epidural Anesthesia and Analgesia (TEA) in Patients with Rib Fractures

Abstract

BackgroundWe analyzed the results of surgical reduction and fixation of ribs under thoracic epidural anesthesia and analgesia (TEA) in patients who had no more than 3 consecutive rib fractures with severe displacement to examine the clinical usefulness of this method.Materials and MethodsFrom May 2008 to March 2010, 35 patients underwent surgical reduction and fixation of ribs under TEA. We reviewed the indications for this technique, number of fixed ribs, combined surgical procedures for thoracic trauma, intraoperative cardiopulmonary events, postoperative complications, reestablishment of enteral nutrition, and ambulation.ResultsThe indications of TEA were malunion or nonunion of fractured ribs in 29 (82.9%; first operation) and incompletely ribs under previous general anesthesia in 6 (17.1%; second operation). The average number of fixed ribs per patient was 1.7 (range: 1~3). As a combined operation for thoracic trauma, 17 patients (48.6%) underwent removal of intrathoracic hematomas, and we performed repair of lung parenchyma (2), wedge resection of lung (1) for accompanying lung injury and pericardiostomy (1) for delayed hemopericardium. No patient had any intraoperative cardiopulmonary event nor did any need to switch to general anesthesia. We experienced 3 postoperative complications (8.6%): 2 extrapleural hematomas that spontaneously resolved without treatment and 1 wound infection treated with secondary closure of the wound. All patients reestablished oral feeding immediately after awakening and resumed walking ambulation the day after operation.ConclusionThoracic epidural anesthesia and analgesia (TEA) may positively affect cardiopulmonary function in the perioperative period. Moreover, this technique leads to an earlier return of gastrointestinal function and early ambulation without severe postoperative complications, resulting in a shortened hospital stay and lowered costs.

Quality of life after major trauma with multiple rib fractures

“…Trauma patients are a notoriously mobile population and follow-up data can be very difficult to achieve. Although the natural history of any rib fracture is a process of callus formation and healing by bony union, there are many reports of malunion, pseudarthrosis formation, residual deformity, clicking and movement and of course pain which fails to resolve over the expected 8-12 week timeframe for complete healing after injury [14,15].…”

Bilateral continuous serratus anterior plane block: An effective alternative for bilateral multiple rib fracture analgesia

“…Effective analgesia ameliorates the pulmonary complications in patients with rib fractures and abbreviates the hospital stay. [ 3 ] Although multiple therapeutic options are available, pain management can be difficult. [ 4 ]…”

“…TEB is considered the gold standard for providing analgesia for thoracic region, especially for bilateral pathology. [ 3 ] Paravertebral or ESPB has emerged as an effective alternative, but our patient had multiple injuries due to which she was unable to sit or lie in lateral decubitus position, and we decided to go for ultrasound-guided bilateral continuous SAPB which requires minimal patient cooperation for positioning and is feasible in patients who cannot be positioned for the former blocks.…”

Ablación térmica de nervios intercostales por radiofrecuencia para dolor por fracturas costales múltiples

“…Los resultados observados en nuestro estudio están en concordancia con la literatura mundial al observar una reducción importante del consumo de morfina diaria. 15,19 Cirujano General 2020; 42 (1): 24-30 www.medigraphic.com/cirujanogeneral www.medigraphic.org.mx…”