L. Williams1, C. Talley1, D. Davenport1, K. Brumagen1, J. S. Roth1 1University Of Kentucky,Surgery,Lexington, KY, USA
Introduction: Pain control in blunt thoracic trauma (BTT) patients with multiple rib fractures is of critical importance to assure adaquate ventilation and avoid possible complications such as atelectasis, pneumonia, and subsequent respiratory compromise. The objective of our study was to compare epidural analgesia (EPID), intravenous patient-controlled analgesia (IV-PCA), & oral analgesia (PO) with outcome measures of visual analog pain scale (VAS) scores, length of stay (LOS), and complication rates.
Methods: We analyzed the trauma registry of 348 isolated non-intubated blunt thoracic trauma patients between May 2012 and December 2013 at our Level 1 trauma center. We studied those with age > 18 years, ≥3 rib fractures, a chest abbreviated injury scale (AIS) ≥3 and excluded non-chest AIS ≥4, emergent surgery, and LOS <24hrs. Patient demographics, mechanism and extent of injury, complications including intubations, VAS scores, and LOS were collected for each patient. VAS scores were averaged in increments of 0-6, 6-12, 12-24, 24-48, and 48-72 hours from admission. Estimated VAS scores as well as LOS were adjusted for age, gender, number of rib fractures, injury severity score (ISS), and chest-AIS.
Results: Demographics showed similarity among the groups except for a higher BMI in the IV-PCA group. Admission VAS was higher for EPID (7.5 vs 7.1 vs 6.3) compared to IV-PCA and PO. EPID patients had more median rib fractures (8 vs 6.5 vs 5, p<.001) and more flail chests (17.2% vs 5.0% vs 4.0%, p=0.01) than IV-PCA and PO. EPID led to significantly lower pain at 24-72 hours compared to IV-PCA and PO. Median LOS is higher in both IV-PCA and EPID compared to PO (6 vs 5 vs 3 days, p<.001). Thirteen patients required intubation after admission, 4 had IV-PCA and 9 had PO. No patients requiring intubation had an EPID.
Conclusion: Significant pain control for seriously injured blunt chest trauma patients can be achieved with EPID but with increased LOS. There were no intubations after EPID was started. IV-PCA however may increase LOS without decreasing VAS as significantly as EPID demonstrating diminished utility in the treatment of isolated blunt chest trauma.
