A Comparison of Continuous Thoracic Epidural Analgesia with Bupivacaine Versus Bupivacaine and Dexmedetomidine for Pain Control in Patients with Multiple Rib Fractures

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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Thoracic epidural analgesia or mechanical ventilation in management of patients with multiple rib fractures

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-198107000-00025 ◽

1981 ◽

Vol 21 (7) ◽

pp. 586

Author(s):

&NA;

Keyword(s):

Mechanical Ventilation ◽

Epidural Analgesia ◽

Rib Fractures ◽

Thoracic Epidural Analgesia ◽

Multiple Rib Fractures ◽

Thoracic Epidural

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Bilateral Paravertebral Block versus Thoracic Epidural Analgesia for Pain Control Post-Cardiac Surgery: A Randomized Controlled Trial

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1668496 ◽

2018 ◽

Vol 68 (05) ◽

pp. 410-416 ◽

Cited By ~ 5

Author(s):

Hatem A. El Shora ◽

Ahmed A. El Beleehy ◽

Amr A. Abdelwahab ◽

Gaser A. Ali ◽

Tarek E. Omran ◽

...

Keyword(s):

Cardiac Surgery ◽

Epidural Analgesia ◽

Pain Control ◽

Controlled Trial ◽

Thoracic Epidural Analgesia ◽

Paravertebral Block ◽

Ultrasound Guided ◽

Thoracic Epidural ◽

Group I ◽

Post Cardiac Surgery

Background Adequate pain control after cardiac surgery is essential. Paravertebral block is a simple technique and avoids the potential complications of epidural catheters. The objective of this study is to compare the effect of ultrasound-guided bilateral thoracic paravertebral block with thoracic epidural block on pain control after cardiac surgery. Materials and Methods Between March 2016 and 2017, 145 patients who had cardiac surgery through median sternotomy were randomized by stratified blocked randomization into two groups. Group I (n = 70 patients) had bilateral ultrasound-guided thoracic paravertebral block and Group II (n = 75 patients) had thoracic epidural analgesia. The primary end point was the postoperative visual analogue scale (VAS). The duration of mechanical ventilation, intensive care unit (ICU), and hospital stay were the secondary end points. The study design is a randomized parallel superiority clinical trial. Results Both groups had similar preoperative and operative characteristics. No significant difference in VAS measured immediately after endotracheal extubation then after 12, 24, and 48 hours between groups (p = 0.45). Pain score significantly declined with the repeated measures (p < 0.001) and the decline was not related to the treatment group. Postoperative pain was significantly related to diabetes mellitus (p = 0.039). Six patients in group I (8.5%) required an additional dose of morphine versus three patients (4%) in group II (p = 0.30). Patients in group I had significantly shorter ICU stay (p = 0.005) and lower incidence of urinary retention (p = 0.04) and vomiting (p = 0.018). No difference was found in operative complications between groups. Conclusion This randomized parallel controlled trial demonstrates that ultrasound-guided paravertebral block is safe and effective method for relieving post-cardiac surgery sternotomy pain compared with thoracic epidural analgesia but not superior to it.

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Thoracic epidural analgesia vs. intravenous analgesia after lung transplant

Case Studies in Surgery ◽

10.5430/css.v5n2p4 ◽

2019 ◽

Vol 5 (2) ◽

pp. 4

Author(s):

Enten G ◽

Puri S ◽

Patel K ◽

Stachura Z ◽

Schwaiger E ◽

...

Keyword(s):

Length Of Stay ◽

Epidural Analgesia ◽

Pain Control ◽

Lung Transplant ◽

Total Duration ◽

Thoracic Epidural Analgesia ◽

Positive Pressure ◽

Opioid Use ◽

Thoracic Epidural ◽

Number Of Patients

Objective: Few reports have evaluated postoperative continuous thoracic epidural analgesia on patients who received a lung transplant. This analgesic modality may facilitate extubation, early ambulation, and achieve adequate pain control with minimization of opioid use. An opioid sparing technique could minimize the side effects of opioids such as ileus, constipation, and somnolence.Methods: A retrospective chart review following local IRB approval was performed. A total of 97 patients’ charts were collected, from April 2015 to March 2017. Forty-eight patients received T6-7 epidural, and forty-nine patients received standard intravenous (IV) analgesia. Outcome measures collected included length of intensive care unit stay, total duration of hospitalization, need for reintubation or noninvasive intermittent positive pressure ventilation (NIPPV), need for IV lidocaine gtt, and total narcotics consumption during hospitalization in milligrams of morphine equivalents (MME).Results: Both groups were comparable in age, BMI, and race/gender distribution. Additionally, patient pain requirements were comparable between groups. However, a significantly smaller proportion of thoracic epidural patients required NIPPV post-operatively, (20.4%, 53.2%: p = .0015). Further, the number of patients requiring reintubation was almost halved, (12.5%, 21.3%: NS). Patients receiving thoracic epidural also experienced shorter ICU times (p = .0335) and on average, an overall reduced length of stay by six days.Conclusions: For patients undergoing lung transplant, epidural analgesia is a viable alternative to IV pain control. Further, it significantly reduced respiratory depression and length of stay in the ICU. More refined comparisons can be made by conducting a precise prospective study with a more structured protocol in place.

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Thoracic epidural analgesia in a child with multiple traumatic rib fractures

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2015.05.008 ◽

2015 ◽

Vol 27 (8) ◽

pp. 685-691 ◽

Cited By ~ 3

Author(s):

Brian M. Keech

Keyword(s):

Epidural Analgesia ◽

Rib Fractures ◽

Thoracic Epidural Analgesia ◽

Thoracic Epidural

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Improved Outcomes Associated with the Liberal Use of Thoracic Epidural Analgesia in Patients with Rib Fractures

Pain Medicine ◽

10.1093/pm/pnw199 ◽

2016 ◽

pp. pnw199 ◽

Cited By ~ 3

Author(s):

Courtney D. Jensen ◽

Jamie T. Stark ◽

Lewis L. Jacobson ◽

Jan M. Powers ◽

Michael F. Joseph ◽

...

Keyword(s):

Epidural Analgesia ◽

Rib Fractures ◽

Thoracic Epidural Analgesia ◽

Thoracic Epidural ◽

Improved Outcomes

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Thoracic paravertebral block versus thoracic epidural analgesia for post-operative pain control in open pancreatic surgery: A randomized controlled trial

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2018.04.013 ◽

2018 ◽

Vol 48 ◽

pp. 41-45 ◽

Cited By ~ 5

Author(s):

Jacob L. Hutchins ◽

Anthony J. Grandelis ◽

Alexander M. Kaizer ◽

Eric H. Jensen

Keyword(s):

Randomized Controlled Trial ◽

Epidural Analgesia ◽

Pain Control ◽

Pancreatic Surgery ◽

Controlled Trial ◽

Thoracic Epidural Analgesia ◽

Thoracic Paravertebral Block ◽

Thoracic Epidural ◽

Randomized Controlled ◽

Post Operative Pain

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

Critical Care Research and Practice ◽

10.1155/2019/4837591 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

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.

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

The American Surgeon ◽

10.1177/000313481708300430 ◽

2017 ◽

Vol 83 (4) ◽

pp. 399-402 ◽

Cited By ~ 5

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.

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