Magnesium sulfate versus fentanyl as adjuvants to bupivacaine for thoracic epidural analgesia in multiple traumatic fracture ribs: a randomized controlled study

Abstract

Background Traumatic rib fractures morbidity and mortality rates are very high, reaching 16%. Pain-induced inadequate respiratory effort is recognized as a main contributing factor. This study focused on the role of different adjuvants of thoracic epidural analgesia (TEA) in pain management. Patients and methods A total of 60 adult patients aged 20–50 years with American Society of Anesthesiologists grades I–II with more than or equal to two rib fractures were enrolled. TEA was done within 12–24 h of presentation. Group B included patients who received mid-TEA. The dose given was 8 ml of 0.125% bupivacaine (loading dose), and then infusion started at a rate of 8 ml/h. Group M included patients who received mid-TEA with 8 ml volume of 0.125% bupivacaine and 30 mg/kg magnesium sulfate (loading dose), and then infusion was given at a rate of 8 ml/h. Group F included patients who received mid-TEA with 8 ml volume of 0.125 bupivacaine and 2 μg/ml fentanyl (loading dose), and then infusion of the same mixture at a rate of 8 ml/h. Data were collected regarding 48 h visual analog scale, partial pressure of arterial oxygen, partial pressure of arterial carbon dioxide, hemodynamics and days of ICU stay. Results A statistically significant lower visual analog scale value was recorded in groups M and F in the first hour and 48 h postoperatively (P < 0.001). Partial pressure of arterial oxygen tension was significantly higher in groups M and F in the first hour and 12th hour (P < 0.001 and < 0.03, respectively). Duration of ICU stay was significantly shorter in group F (P < 0.001). Conclusion TEA by bupivacaine and fentanyl can offer optimal pain alleviation and shorter duration of ICU stay in patients with multiple traumatic fractured ribs.