Comparison between lumbar and thoracic epidural morphine for severe isolated blunt chest wall trauma: a randomized open-label trial.
OBJECTIVE
The aim of this randomized, parallel-arm, open-label trial was to compare lumbar versus thoracic epidural morphine for severe isolated blunt chest wall injury as regards the incidence of pulmonary complications and pain control.


METHODS
Fifty-five patients who sustained severe isolated blunt chest wall trauma were randomized using a computer-generated list to receive epidural morphine injection every 24 h through an epidural catheter inserted into the lumbar (n = 28) or thoracic (n = 27) region. Need for mechanical ventilation, incidence of pneumonia, arterial blood gas values, and pulmonary function tests were compared in both groups. Pain scores, supplemental analgesic consumption, length of intensive care unit (ICU) stay, and occurrence of epidural morphine-related side effects were compared as well. Primary outcome measures were need for mechanical ventilation and incidence of pneumonia.


RESULTS
Five (17.9 %) patients in the lumbar group were mechanically ventilated, compared with six (22.2 %) in the thoracic group (hazard ratio 1.35; 95 % CI 0.41-4.4; P = 0.611). Seven (25 %) patients in the lumbar group developed pneumonia versus six (22.2 %) in the thoracic group (hazard ratio 0.97; 95 % CI 0.33-2.9; P = 0.96). Both groups were comparable as regards the duration of mechanical ventilation (P = 0.141) and length of ICU stay (P = 0.227). Pain scores, supplemental analgesic consumption, pulmonary function, and occurrence of epidural morphine-related side effects were, likewise, comparable (P > 0.05).


CONCLUSIONS
Lumbar and thoracic epidural morphine administered as once-daily injection to patients with severe isolated blunt chest wall trauma were comparable in terms of pain control, incidence of pulmonary complications, and occurrence of epidural morphine-related side effects.
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt. drsmichel@hotmail.com
Sameh Michel
SM
Hakim
Fahmy S
FS
Latif
Sherif G
SG
Anis
D000328:Adult; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003422:Critical Care; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010102:Oxygen Inhalation Therapy; D010147:Pain Measurement; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D016019:Survival Analysis; D013898:Thoracic Injuries / Q000150:complications*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications*
D000701:Analgesics, Opioid; D009020:Morphine