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Thoracic epidural analgesia versus intravenous opioid analgesia for the treatment of rib fracture pain

Background: Rib fractures are common and pain from rib fractures can be difficult to control, particularly in first few days. This pain may affect the pulmonary function, morbidity and intensive care unit stay. The limited evidence from the previous studies illustrates the difficulties in determining the relevant outcomes.

Objective: To compare and evaluate the efficacy of epidural analgesia versus systemic intravenous opioid analgesia for the treatment of rib fracture pain.

Methods: The case records of patients with rib fractures from January 1, 2007 to June 30, 2010, were reviewed. Data was collected from 94 patients who had three or more rib fractures. Entry criteria included patients older than 18 years with 3 or more than 3 ribs fractures and no contraindications to epidural catheter placement. All patients had initiation of thoracic epidural analgesia with bupivacaine or intravenous opioid analgesia within 24 hours of admission in intensive care unit.

Results: Injury Severity Score was not significantly different between two groups, while patients in epidural group had significantly more rib fractures. Patients who received epidural analgesia had significantly lower pain scores, improved pulmonary functions and decreased intensive care unit stay.

Conclusion: Thoracic epidural analgesia provided better pain control than systemic intravenous opioid analgesia in rib fractures. However, further research is needed to strengthen this conclusion.

Author(s): S H Waqar , Kamal Nasir , M A Zahid

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