title: Epidural versus intravenous pain control in elderly patients with rib fractures.
abstract: BACKGROUND
  Epidural catheters are used in older patients with rib fractures to improve outcome. We reviewed the efficacy of epidural analgesia (EA) compared with intravenous narcotics (IVN) in this population.
  
  
  METHODS
  Rib fracture patients >55 years old admitted to our level I trauma center from 1999 through 2002 were reviewed for demographics, Injury Severity Score (ISS), Abbreviated Injury Score for chest, length of stay, cardiopulmonary comorbidities, complications, and type of analgesia.
  
  
  RESULTS
  There were 187 patients: 72 men and 115 women. The mean age was 77 years. For ISS <9, length of stay for EA patients was 12 +/- 5 days versus 5 +/- 4 days for IVN patients (P < 0.001). Complications occurred in 9 of 10 EA patients versus 21 of 52 IVN patients (P < 0.001). No difference was noted in length of stay for patients with ISS > or =9. Complications in the high ISS group occurred in 29 of 43 EA patients versus 37 of 82 IVN patients (P <0.05). Stratification of patients based on low versus high Abbreviated Injury Score for chest yielded similar results.
  
  
  CONCLUSIONS
  EA is associated with prolonged length of stay and increased complications in elderly patients, particularly those with less significant injuries, regardless of cardiopulmonary comorbidities. EA for elderly patients with rib fractures should be prospectively re-evaluated.
authors.affiliation: Division of Trauma Surgery, William Beaumont Hospital, 3601 W. Thirteen Mile Rd., Royal Oak, MI 48073, USA.
authors.forename: Alicia N
authors.initials: AN
authors.lastname: Kieninger
authors.forename: Holly A
authors.initials: HA
authors.lastname: Bair
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Bendick
authors.forename: Greg A
authors.initials: GA
authors.lastname: Howells
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000150:complications; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008171:Lung Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D012253:Rib Fractures / Q000150:complications*; D015599:Trauma Severity Indices
chemical_list: D000701:Analgesics, Opioid