scholarly journals Epidural Analgesia for Severe Chest Trauma: An Analysis of Current Practice on the Efficacy and Safety

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Jesse Peek ◽  
Reinier B. Beks ◽  
B. Feike Kingma ◽  
Marije Marsman ◽  
Jelle P. Ruurda ◽  
...  
Keyword(s):  
Side Effects ◽  
Epidural Analgesia ◽  
Pain Control ◽  
Chest Trauma ◽  
Major Complication ◽  
Rib Fractures ◽  
Efficacy And Safety ◽  
Sensory Blockade ◽  
Multiple Rib Fractures ◽  
Opioid Intoxication

Background. Adequate pain control is essential in the treatment of patients with traumatic rib fractures. Although epidural analgesia is recommended in international guidelines, the use remains debatable and is not undisputed. The aim of this study was to describe the efficacy and safety of epidural analgesia in patients with multiple traumatic rib fractures.Methods. A retrospective cohort study was performed. Patients with ≥3 rib fractures following blunt chest trauma who received epidural analgesia between January 2015 and January 2018 were included. The main outcome parameters were the success rate of epidural analgesia and the incidence of medication-related side effects and catheter-related complications.Results. A total of 76 patients were included. Epidural analgesia was successful in a total of 45 patients (59%), including 22 patients without and in 23 patients with an additional analgesic intervention. In 14 patients (18%), epidural analgesia was terminated early without intervention due to insufficient sensory blockade (n=4), medication-related side effects (n=4), and catheter-related complications (n=6). In 17 patients (22%), the epidural catheter was removed after one or multiple additional interventions due to insufficient pain control. Minor epidural-related complications or side effects were encountered in 36 patients (47%). One patient had a major complication (opioid intoxication).Conclusion. Epidural analgesia was successful in 59% of patients; however, 30% needed additional analgesic interventions. As about half of the patients had epidural-related complications, it remains debatable whether epidural analgesia is a sufficient treatment modality in patients with multiple rib fractures.

scholarly journals Ultrasound-guided continuous serratus anterior plane block for combined trauma: case series

2019 ◽  
Vol 13 (1-4) ◽  
pp. 22-26
Author(s):  
A. T. Ibragimov ◽  
E. E. Antipin ◽  
D. A. Svirsky ◽  
B. N. Shah ◽  
S. V. Kovalev ◽  
...  
Keyword(s):  
Side Effects ◽  
Chest Trauma ◽  
Case Series ◽  
Rib Fractures ◽  
Ultrasound Guided ◽  
Serratus Anterior ◽  
Multiple Rib Fractures ◽  
Trauma Case ◽  
Anterior Plane

Clinical cases of the use of continuous ultrasound-guided Serratus anterior plane block in patients with severe combined trauma, dominant chest trauma and multiple rib fractures. The method allows for excellent long-term analgesia without the need for additional administration of the drug, there are no side effects.

Comparative Analysis of the Paravertebral Analgesic Pump Catheter with the Epidural Catheter in Elderly Trauma Patients with Multiple Rib Fractures

2017 ◽  
Vol 83 (4) ◽  
pp. 399-402 ◽  
Author(s):  
Brian S. Shapiro ◽  
Tarik Wasfie ◽  
Mathew Chadwick ◽  
Kimberly R. Barber ◽  
Raquel Yapchai
Keyword(s):  
Epidural Analgesia ◽  
Injury Severity Score ◽  
Severity Score ◽  
Pain Control ◽  
Injury Severity ◽  
Rib Fractures ◽  
Trauma Patients ◽  
Multiple Rib Fractures ◽  
Epidural Catheters ◽  
Elderly Trauma Patients

Presently, trauma guidelines recommend epidural analgesia as the optimal modality of pain relief from rib fractures. They are not ideally suited for elderly trauma patients and have disadvantages including bleeding risk. The paravertebral analgesic pump (PVP) eliminates such disadvantages and includes ease of placement in the trauma setting. This study compares pain control in patients treated by EPI versus PVP. This is a retrospective, historical cohort study comparing two methods of pain management in the trauma setting. Before 2010, patients who had epidural catheters (EPI) placed for pain control were compared with patients after 2010 in which the PVP was used. All patients had multiple rib fractures as diagnosed by CT scan. Analysis was adjusted for age, number of fractures, and comorbid conditions. Multiple linear regression analysis was conducted to compare average reported pain. A total of 110 patients, 31 PVP and 79 epidural catheters, were included in the study. Overall mean age was 65 years. The mean Injury Severity Score was 12.0 (EPI) and 11.1 (PVP). Mean number rib fractures was 4.29 (EPI) and 4.71 (PVP). PVP was associated with a 30 per cent greater decrease in pain than that seen with EPI (6.0–1.9 vs 6.4–3.4). After controlling for age, Injury Severity Score, and number of rib fractures, there were no differences in intensive care unit or total length of stay (P = 0.35) or in pain score (3.76 vs 3.56, P = 0.64). In conclusion, the PVP compares well with epidural analgesia in older trauma patients yet is safe, well tolerated, and easily inserted.

Posterior paramedian subrhomboidal analgesia versus thoracic epidural analgesia for pain control in patients with multiple rib fractures

2016 ◽  
Vol 81 (3) ◽  
pp. 463-467 ◽  
Author(s):  
Casey L. Shelley ◽  
Stepheny Berry ◽  
James Howard ◽  
Martin De Ruyter ◽  
Melissa Thepthepha ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Pain Control ◽  
Rib Fractures ◽  
Thoracic Epidural Analgesia ◽  
Multiple Rib Fractures ◽  
Thoracic Epidural

Ketamine infusion for pain control in adult patients with multiple rib fractures

2019 ◽  
Vol 86 (2) ◽  
pp. 181-188 ◽  
Author(s):  
Thomas W. Carver ◽  
Nathan W. Kugler ◽  
Janelle Juul ◽  
William J. Peppard ◽  
Karin Madsen Drescher ◽  
...  
Keyword(s):  
Pain Control ◽  
Rib Fractures ◽  
Adult Patients ◽  
Ketamine Infusion ◽  
Multiple Rib Fractures

Epidural analgesia improves outcome after multiple rib fractures

Surgery ◽  
2004 ◽  
Vol 136 (2) ◽  
pp. 426-430 ◽  
Author(s):  
Eileen M. Bulger ◽  
Thomas Edwards ◽  
Patricia Klotz ◽  
Gregory J. Jurkovich
Keyword(s):  
Epidural Analgesia ◽  
Rib Fractures ◽  
Multiple Rib Fractures

scholarly journals Effect of Thoracic Epidural Analgesia in Patients of Traumatic Multiple Rib Fractures withNeurotrauma: A Study Done in a SpecializedNeuro-ICU in Bangladesh

2020 ◽  
Vol 6 (1) ◽  
pp. 24-28
Author(s):  
SM Ahsanul Habib ◽  
Lutful Aziz ◽  
Arifa Sultana ◽  
Taneem Mohammad ◽  
Kaisar Haroon
Keyword(s):  
Epidural Analgesia ◽  
Distress Syndrome ◽  
Rib Fractures ◽  
Thoracic Epidural Analgesia ◽  
Pain Rating ◽  
Analgesic Drug ◽  
Multiple Rib Fractures ◽  
Thoracic Epidural ◽  
Chest Expansion ◽  
Length Of Icu Stay

analgesic administration as well as between early and delayed epidural analgesia. Monitoring was done to identify if any complications occur either due to the procedure or anaesthetic or analgesic drug itself. Results: A total number of 100 patients were recruited for this study. Following thoracic epidural analgesia (TEA), pain rating improved in 76.0% cases; coughing was diminished in 78.0% cases, while suctioning was improved in 68.0% cases. Besides, physiotherapy and positioning improvement were found in 68.0% cases and 72.0% cases respectively, while chest expansion was improved in 88.0% cases. Thoracic epidural analgesia was given soon after injury and had given a significant improvement compared with the patients who got the delayed TEA considering in ventilation (78.0% vs. 22.0%) and in mobilization (72.0% vs. 32.0%)(p<0.001); however, weaning from the ventilator or length of ICU stay had no difference among those two groups. Moreover, pneumonia, acute respiratory distress syndrome (ARDS) and mortality reported more in those who got delayed TEA(p<0.05). Complications included the misplacement of catheter (2.0%), hypotension (8.0%), bradycardia (6.0%) and respiratory depression (2.0%). Conclusion: Thoracic epidural analgesia which is given soon after injury has showed better prognosis and outcomes in the patients suffering from multiple rib fractures with neurotrauma. Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 24-28

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