[Comparison of clinical effectiveness of thoracic epidural and intravenous patient-controlled analgesia for the treatment of rib fractures pain in intensive care unit].
BACKGROUND
The results of thoracic epidural and systemic patient controlled analgesia practice were evaluated retrospectively in patients with thoracic trauma.


METHODS
Patients who were admitted to the intensive care unit between 1997 and 2003, with a diagnosis of multiple rib fractures related to thoracic trauma were evaluated retrospectively. Data were recorded from 49 patients who met the following criteria; three or more rib fractures, initiation of PCA with I.V. phentanyl or thoracic epidural analgesia with phentanyl and bupivacaine.


RESULTS
There were no significant differences between the groups concerning injury severity score. APACHE II score (8.1+/-1.6 and 9.2+/-1.7) and the number of rib fractures (4+/-1.1 and 6.8+/-2.7) were higher in thoracic epidural analgesia group (p<0.05). Pain scores of patients who received thoracic epidural analgesia were significantly lower as from 6th hour during whole therapy (p<0.05). Length of intensive care unit stay (15.6+/-5.9 and 12.1+/-4.4 day) was found to be shorter in thoracic epidural analgesia group (p<0.05). There were no differences between the groups regarding mechanical ventilation requirement, pulmonary and cardiac complications.


CONCLUSIONS
We suggest that the use of thoracic epidural analgesia with infusion of local anesthetics and opioids are more appropriate as they provide more effective analgesia and shorten length of intensive care unit stay in chest trauma patients with more than three rib fractures who require intensive care.
Topçu
Ismet
I
Department of Anesthesiology and Reanimation, Medicine Faculty of Celal Bayar University, Manisa, Turkey. topcuismet@yahoo.com
Ekici
Zeynep
Z
Sakarya
Melek
M
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007268:Injections, Epidural; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D012189:Retrospective Studies; D012253:Rib Fractures / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine