Comparison of clinical effectiveness of thoracic epidural and intravenous patient-controlled analgesia for the treatment of rib fractures pain in intensive care unit

BACKGROUND The results of thoracic epidural and systemic patient controlled analgesia practice were evaluated retrospectively in patients with thoracic trauma.
METHODS Patients who were admitted to the intensive care unit between 1997 and 2003, with a diagnosis of multiple rib fractures related to thoracic trauma were evaluated retrospectively. Data were recorded from 49 patients who met the following criteria; three or more rib fractures, initiation of PCA with I.V. phentanyl or thoracic epidural analgesia with phentanyl and bupivacaine. RESULTS There were no significant differences between the groups concerning injury severity score. APACHE II score (8.1±1.6 and 9.2±1.7) and the number of rib fractures (4±1.1 and 6.8±2.7) were higher in thoracic epidural analgesia group (p<0.05). Pain scores of patients who received thoracic epidural analgesia were significantly lower as from 6th hour during whole therapy (p<0.05). Length of intensive care unit stay (15.6±5.9 and 12.1±4.4 day) was found to be shorter in thoracic epidural analgesia group (p<0.05). There were no differences between the groups regarding mechanical ventilation requirement, pulmonary and cardiac complications. CONCLUSION We suggest that the use of thoracic epidural analgesia with infusion of local anesthetics and opioids are more appropriate as they provide more effective analgesia and shorten length of intensive care unit stay in chest trauma patients with more than three rib fractures who require intensive care.

Toraks travmalý hastalarda intravenöz hasta kontrollü analjezi ile torakal epidural hasta kontrollü analjezinin klinik etkinliðinin karþýlaþtýrýlmasý

AMAÇ Toraks travmalý hastalarda torasik epidural ve sistemik hasta kontrollü analjezi uygulamalarýnýn yoðun bakým tedavi sürecine etkileri geriye dönük olarak araþtýrýldý.
GEREÇ VE YÖNTEM Çalýþmamýzda 1997 ve 2003 yýllarý arasýnda yoðun bakým ünitesine (YBÜ) alýnan toraks travmasý sonrasý kot kýrýðý oluþan ve yoðun bakým tedavisi uygulanan olgular deðerlendirildi. Üç veya daha çok kot kýrýðý olan, fentanil ile intravenöz hasta kontrollü analjezi veya bupivakain ve fentanil ile torasik epidural analjezi uygulanan 49 olgu çalýþmaya alýndý. BULGULAR Gruplar arasýndaki yaralanma aðýrlýk skorunda fark saptanmadý. APACHE II skor deðerleri (8,1±1,6 ve 9,2±1,7) ve kýrýk kot sayýsý ortalama deðerleri (4±1,1 ve 6,8±2,7) torasik epidural uygulanan gruptaki hastalarda daha yüksekti (p<0,05). Torasik epidural analjezi uygulanan hastalarda tedavi süresince 6. saatten itibaren anlamlý düzeyde düþük aðrý skorlarý gözlendi (p<0,05). Gruplarýn YBÜ’de kalma süresi (15,6±5,9 ve 12,1±4,4 gün) torasik epidural analjezi grubunda daha kýsa olarak saptandý (p<0,05). Gruplar arasýnda mekanik ventilasyon gereksinimi, pulmoner ve kardiyak komplikasyonlar açýsýndan fark saptanmadý. SONUÇ Üçten fazla kot kýrýðý olan toraks travmalý olgularýn yoðun bakým tedavisinde, analjezi amacýyla lokal anestezik ve opioid infüzyonu ile torasik epidural analjezi kullanýmýnýn daha etkili analjezi saðlamasý ve YBÜ yatýþ süresini kýsaltmasý nedeniyle daha uygun olacaðý kanýsýndayýz.