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Year : 2018  |  Volume : 31  |  Issue : 1  |  Page : 199-204

Comparisonof thoracic epidural analgesia versus parenteral analgesia for traumatic multiple rib fractures

1 Department of CardiothoracicSurgery, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt
2 Department of General Surgery, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt

Correspondence Address:
Mohamed M Abdelsabour
Shebeen El-Kom, Menoufia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mmj.mmj_693_16

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Objective The aim of this study was to compare between epidural analgesia and parenteral analgesia for management of traumatic multiple rib fractures. Background Chest wall trauma is most commonly seen after motor vehicle collision and accounts for 8% of all trauma admissions. It is a marker of severity and contributes to the morbidity and mortality of injured patients, with the elderly and patients with poor respiratory reserve being most vulnerable. Rib fractures are the commonest of all chest injuries and are identified in 10% of patients after trauma. Pain limits one's ability to cough and breathe deeply, resulting in sputum retention and atelectasis. These factors result in decreased lung compliance, ventilation-perfusion mismatch, and respiratory distress. This can result in serious respiratory complications. Patients and methods We conducted a prospective, randomized study of 30patients complaining of multiple rib fractures who were admitted to the thoracic surgery unit in Menoufia University hospitals between December 2015 and July 2016. The patients were randomly divided into two equal groups of 15patients. The first group was subjected to epidural analgesia, and the second group was given ketorolac tromethamine, a NSAID. Results Our study included 21males and nine females, with a mean age of 41.8years. The epidural group showed that the pain score significantly lowered than systemic analgesia group at 6 and 24h after treatment, along with a significant improvement in arterial blood gases, duration of hospital, and ICU stay. Conclusion Thoracic epidural analgesia is more effective regarding pain score, arterial blood gases, hospital stay, ICU stay, and duration of mechanical ventilation but has no significant value in need for ICU stay, need for mechanical ventilation, or improvement in pH.

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