Abstract

PURPOSE
The aim of this randomized, parallel-arm, open-label trial was to compare lumbar versus thoracic epidural morphine for severe isolated blunt chest wall injury as regards the incidence of pulmonary complications and pain control.
METHODS
Fifty-five patients who sustained severe isolated blunt chest wall trauma were randomized using a computer-generated list to receive epidural morphine injection every 24 h through an epidural catheter inserted into the lumbar (n = 28) or thoracic (n = 27) region. Need for mechanical ventilation, incidence of pneumonia, arterial blood gas values, and pulmonary function tests were compared in both groups. Pain scores, supplemental analgesic consumption, length of intensive care unit (ICU) stay, and occurrence of epidural morphine-related side effects were compared as well. Primary outcome measures were need for mechanical ventilation and incidence of pneumonia.
RESULTS
Five (17.9 %) patients in the lumbar group were mechanically ventilated, compared with six (22.2 %) in the thoracic group (hazard ratio 1.35; 95 % CI 0.41-4.4; P = 0.611). Seven (25 %) patients in the lumbar group developed pneumonia versus six (22.2 %) in the thoracic group (hazard ratio 0.97; 95 % CI 0.33-2.9; P = 0.96). Both groups were comparable as regards the duration of mechanical ventilation (P = 0.141) and length of ICU stay (P = 0.227). Pain scores, supplemental analgesic consumption, pulmonary function, and occurrence of epidural morphine-related side effects were, likewise, comparable (P > 0.05).
CONCLUSION
Lumbar and thoracic epidural morphine administered as once-daily injection to patients with severe isolated blunt chest wall trauma were comparable in terms of pain control, incidence of pulmonary complications, and occurrence of epidural morphine-related side effects.

Links

Publisher Full Text

Authors

Hakim SM, Latif FS, Anis SG

Institution

Department of Anesthesiology and Intensive Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt. drsmichel@hotmail.com

Source

Journal of anesthesia 26:6 2012 Dec pg 836-44

MeSH

Adult
Analgesia, Epidural
Analgesia, Patient-Controlled
Analgesics, Opioid
Female
Humans
Intensive Care
Kaplan-Meier Estimate
Length of Stay
Lumbosacral Region
Male
Middle Aged
Morphine
Oxygen Inhalation Therapy
Pain Measurement
Pneumonia
Respiration, Artificial
Respiratory Function Tests
Survival Analysis
Thoracic Injuries
Thoracic Vertebrae
Treatment Outcome
Wounds, Nonpenetrating

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22674157