Acute pain services in flail chest-a prospective randomized trial of epidural versus parenteral analgesia in mechanically ventilated ICU patients

• Published in: Egyptian journal of anaesthesia 2015-10, Vol.31 (4), p.327-330
• Main Authors: Ahmed, Syed Moied, Athar, Manazir, Ali, Shahna, Doley, Kashmiri, Siddiqi, Obaid Ahmad, Usmani, Hammad
• Format: Article
• Language: English
• Subjects: Acute pain service; Flail chest; Mechanical ventilation; Parenteral analgesia; Thoracic epidural
• ISSN: 1110-1849; 1687-1804; 1110-1849
• DOI: 10.1016/j.egja.2015.06.001

Flail chest following blunt trauma chest generally leads to severe pulmonary complications. Thoracic epidural analgesia by means of reducing the pain and consequent splinting may prove beneficial in improving the patient outcome in mechanically ventilated ICU patients. Twenty patients, 18–55years of age having⩾3 rib fractures with flail segment, and required mechanical ventilation in the year 2012–14 were included. Patients were randomly divided into groups of 10 patients each to receive either thoracic epidural analgesia with 4mL of 0.125% bupivacaine bolus followed by infusion @ 4mL/h with 2μg/mL fentanyl as adjuvant (Group E) or parenteral analgesia in the form of i.v fentanyl in a dose of 2μg/kg (group P). Duration of mechanical ventilation, change in tidal volume during initial 24h, pneumonia, ARDS, length of ICU stay, mortality along with complication were recorded. Duration of mechanical ventilation was significantly less in Group E than in group P (6±2days v/s 9±3days, p=0.02). There was significant increase of tidal volume in 1st 24h in group E (ΔTV: 156±24mL v/s 78±13mL in group E & P; p