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Thoracic Epidural Analgesia versus Intravenous Patient-Controlled Analgesia for the Treatment of Rib Fracture Pain after Motor Vehicle Crash

Wu, Christopher L. MD; Jani, Niraj D. BS; Perkins, Frederick M. MD; Barquist, Erik MD

The Journal of Trauma: Injury, Infection, and Critical Care: September 1999 - Volume 47 - Issue 3 - p 564-567

Background: Pain from rib fracture pain may affect pulmonary function, morbidity, and length of intensive care unit stay. Previous trials have varied epidural technique within the study and have used several outcome variables.

Methods: The charts of patients who sustained rib fractures after a motor vehicle crash between January 1, 1994, and June 30, 1997, were reviewed. Data were collected from 64 patients who had three or more rib fractures and initiation of intravenous patient-controlled analgesia with morphine or thoracic epidural analgesia with bupivacaine and fentanyl within 24 hours of admission.

Results: Injury Severity Score and Acute Physiology and Chronic Health Evaluation II scores were not significantly different between groups. Patients in the epidural group had significantly more rib fractures and were significantly older. Patients who received epidural analgesia had significantly lower pain scores at all times. There were no differences in the lengths of intensive care unit or hospital stays, or the incidence of pulmonary complications or organ failure between groups.

Conclusion: Thoracic epidural analgesia with bupivacaine and fentanyl provided superior analgesia than intravenous patient-controlled analgesia morphine.

From the Departments of Anesthesia (C.L.W., F.M.P.) and Surgery (N.D.J., E.B.), University of Rochester School of Medicine and Dentistry, Rochester, New York.

Address for reprints: Erik Barquist, MD, Department of Surgery; Box SURG, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642; email: erik

© 1999 Lippincott Williams & Wilkins, Inc.