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

Abstract

IntroductionFlail 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.MethodsTwenty patients, 18–55 years 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 4 mL of 0.125% bupivacaine bolus followed by infusion @ 4 mL/h with 2 μg/mL fentanyl as adjuvant (Group E) or parenteral analgesia in the form of i.v fentanyl in a dose of 2 μg/kg (group P). Duration of mechanical ventilation, change in tidal volume during initial 24 h, pneumonia, ARDS, length of ICU stay, mortality along with complication were recorded.ResultsDuration of mechanical ventilation was significantly less in Group E than in group P (6 ± 2 days v/s 9 ± 3 days, p = 0.02). There was significant increase of tidal volume in 1st 24 h in group E (ΔTV: 156 ± 24 mL v/s 78 ± 13 mL in group E & P; p < 0.001). Incidence of pneumonia was 20% and 40% (p = 0.63) while ARDS was 20% and 35% (p = 0.35), in Group E and P respectively. Mortality was not different; however, length of ICU stay was significantly less in group E (9.5 ± 1.6 d v/s 12.8 ± 2.8 d, p = 0.004). No serious adverse effects were observed in any of the groups.ConclusionEpidural analgesia significantly decreased the length of ICU stay and duration of mechanical ventilation in our study population.