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Journals / Ulusal Travma ve Acil Cerrahi Dergisi / 2007 / Cilt: 13 - Sayı: 3

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

Toraks travmalı hastalarda intravenöz hasta kontrollü analjezi ile torakal epidural hasta kontrollü analjezinin klinik etkinliğinin karşılaştırılması

İSMET TOPÇU
Zeynep EKİCİ
Melek SAKARYA
Pages
205–210
DOI
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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

📌 3 Key Takeaways

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Objective & Hypothesis:BACKGROUND The results of thoracic epidural and systemic patient controlled analgesia practice were evaluated retrospectively in patients with thoracic trauma.
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Key Findings & Data: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.
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Conclusion & Impact: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
🔬Design:Research Article
📍Scope:2003 Verileri
⚙️Variables:Ağrı ölçümü · Analjezi · epidural

Abstract

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

Özet

AMAÇ Toraks travmalı hastalarda torasik epidural ve sistemik hasta kontrollü analjezi uygulamalarının yoğun bakım tedavi sürecine etkileri geriye dönük olarak araştırıldı. GEREÇ VE YÖNTEM Çalışmamızda 1997 ve 2003 yılları arasında yoğun bakım ünitesine (YBÜ) alınan toraks travması sonrası kot kırığı oluşan ve yoğun bakım tedavisi uygulanan olgular değerlendirildi. Üç veya daha çok kot kırığı olan, fentanil ile intravenöz hasta kontrollü analjezi veya bupivakain ve fentanil ile torasik epidural analjezi uygulanan 49 olgu çalışmaya alındı. BULGULAR Gruplar arasındaki yaralanma ağırlık skorunda fark saptanmadı. APACHE II skor değerleri (8,1±1,6 ve 9,2±1,7) ve kırık kot sayısı ortalama değerleri (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 anlamlı düzeyde düşük ağrı skorları gözlendi (p<0,05). Grupların YBÜ’de kalma süresi (15,6±5,9 ve 12,1±4,4 gün) torasik epidural analjezi grubunda daha kısa olarak saptandı (p<0,05). Gruplar arasında mekanik ventilasyon gereksinimi, pulmoner ve kardiyak komplikasyonlar açısından fark saptanmadı. SONUÇ Üçten fazla kot kırığı olan toraks travmalı olguların yoğun bakım tedavisinde, analjezi amacıyla lokal anestezik ve opioid infüzyonu ile torasik epidural analjezi kullanımının daha etkili analjezi sağlaması ve YBÜ yatış süresini kısaltması nedeniyle daha uygun olacağı kanısındayız

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Cite This Article

TOPÇU, İ., EKİCİ, Z., SAKARYA, M. (2007). Comparison of clinical effectiveness of thoracic epidural and intravenous patient-controlled analgesia for the treatment of rib fractures pain in intensive care unit. Ulusal Travma ve Acil Cerrahi Dergisi, Cilt: 13 - Sayı: 3, 205–210. https://ajindex.com/articles/324424

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