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World Journal of Surgery

, Volume 19, Issue 3, pp 388–393 | Cite as

Clinical management of blunt trauma patients with unilateral rib fractures: A randomized trial

  • Sheryl G. A. Gabram
  • Robert J. Schwartz
  • Lenworth M. Jacobs
  • Denise Lawrence
  • Marlene A. Murphy
  • Jeffrey S. Morrow
  • Julia S. Hopkins
  • R. Frederic Knauft
Original Scientific Reports

Abstract

Optimal pain management is essential in blunt trauma patients sustaining significant chest trauma. The purpose of this randomized prospective trial was to measure the difference in pulmonary function in nonintubated patients with unilateral multiple rib fractures receiving two modalities of pain relief: systemic narcotic medications alone or local anesthetics given by intrapleural catheter (IPCs). Forty-two patients were randomized to receive systemic narcotic medications or IPCs for pain control. The patients with IPCs statistically had more compromised pulmonary function as measured by forced vital capacity (FVC) on admission; however, they tended toward a greater objective improvement of FVC on discharge. When analyzing a cohort of severely impaired patients (initial FVC<20%), half of the systemic medication patients compared to only 10% of the IPC group failed and required another mode of therapy. Catheter complications were minor and did not contribute to overall morbidity. The IPC patients had fewer failures than the systemic medication patients.

Keywords

Forced Vital Capacity Chest Trauma Blunt Trauma Patient Great Objective Optimal Pain 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Il est essentiel de bien traiter la douleur post traumatique du thorax. Le but de cette étude randomisée a été mesurer la fonction pulmonaire des patients non intubés avec de multiples fractures costales recevant deux sortes d'antalgiques, des narcotiques par voie systématique ou une anesthésie locale par cathéter intra pleural (CIP). Quarante deux patients on été randomisées pour recevoir l'une ou l'autre des modalités thérapeutiques. Les patients dans le groupe CIP avaient une capacité vitale totale diminuée par rapport aux autres á l'admission. Leur CIP s'améliorait davantage à la sortie. Lorsqu'un groupe de patients plus sévèrement atteints (CIP<20%) était analysés, la moitié des patients dans le groupe traité par voie systématique était soulagé alors que 90% des patients traités par CIP ont eu de bons résultats. Les complications en rapport avec le cathéter étaient mineures et n'ont pas influencé les résultats. Les patients avec un CIP ont mieux répondu au traitement.

Resumen

El manejo óptimo de dolor es un componente esencial en los pacientes con trauma torácico cerrado. El propósito de este ensayo prospectivo y randomizado fue determinar diferencias en la función pulmonar entre pacientes con fracturas múltiples unilaterales no intubados y recibiendo dos modalidades de control del dolor: medicación narcótica sistémica solamente o anestésicos locales por catéter intrapleural. Cuarenta y dos pacientes fueron randomizados para recibir medicacións sistémica o anestésicos locales por catéter intrapleural. Los pacientes con el catéter demostraban estadísticamente mayor compromiso de su función pulmonar, según medición de la capacidad vital forzada (FVC) en el momento de la admisión; sin embargo, mostraron una tendencia hacia una mayor mejoría objetiva de la FVC en el momento de su egreso. Al analizar una cohorte de los pacientes más severamente afectados (FVC<20%), la mitad de los tratados mediante narcóticos sistémicos comparado con sólo 10% del grupo del catéter fallaron y requirieron una modalida terapéutica diferente. Las complicaciones de catéter fueron menores y no contribuyeron a la morbilidad global. Los pacientes con catéter exhibieron menos fallas terapéuticas que los tratados con medicación sistémica.

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Copyright information

© Société Internationale de Chirurgie 1995

Authors and Affiliations

  • Sheryl G. A. Gabram
    • 1
    • 2
  • Robert J. Schwartz
    • 2
  • Lenworth M. Jacobs
    • 2
  • Denise Lawrence
    • 1
  • Marlene A. Murphy
    • 2
  • Jeffrey S. Morrow
    • 1
  • Julia S. Hopkins
    • 1
  • R. Frederic Knauft
    • 1
  1. 1.Department of Emergency Medicine/TraumaHartford HospitalHartfordUSA
  2. 2.Department of SurgeryUniversity of Connecticut School of MedicineFarmingtonUSA

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