Abstract
During a 6-year period, 188 patients with chest wall trauma were admitted to the Royal Adelaide Hospital Intensive Care Unit. One hundred and sixty one patients were treated with thoracic epidural analgesia using bupivacaine 0.5% with adrenaline 1/200,000. One hundred and forty seven (91%) were treated conservatively; previously 100% of patients had been treated with mechanical ventilation. Two patients died from severe respiratory failure. Serious side effects associated with epidural analgesia included two cardiac arrests and one epidural infection. Conservative management of chest wall trauma relies largely upon the effectiveness of the pain relief. If complete plain relief is provided then the conservative approach is more likely to be successful. While epidural analgesia can provide complete relief from pain it is not without hazard.
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Worthley LIG (1982) Epidural Analgesia. Sem Resp Med 3:291
North JB, Brophy BP (1979) Epidural Abscess: a hazard of spinal epidural anaesthesia. Aust N Z Surg 49:484
Trinkle JK, Richardson JD, Franz JL, Grover FL, Arom KV, Holmstrom FMG (1975) Management of flail chest without mechanical ventilation. Ann Thorac Surg 19:355
Shackford SR, Virgilio RW, Peters RM (1981) Selective use of ventilator therapy in flail chest injury. J Thorac Cardiovas Surg 81:194
Trahan M (1961) Continuous epidural anaesthesia in multiple fractures of the ribs. Can Anaesth Soc J 8:512
Gibbons J, James O, Quail A (1973) Relief of pain in chest injury. Br J Anaesth 45:1136
Dittmann M, Keller R, Wolff G (1978) A rationale for epidural analgesia in the treatment of multiple ribfractures. Intensive Care Med 4:193
Dittman M, Steenblock U, Kranzlin M, Wolff G (1982) Epidural analgesia or mechanical ventilation for multiple rib fractures? Intensive Care Med 8:89
Moore DC (1975) Intercostal nerve block for postoperative somatic pain following surgery of thorax and upper abdomen. Br J Anaesth 47:284
Guis JA (1940) Paravertebral procaine block in the treatment of postoperative atelectasis: a preliminary report. Surgery 8:832
Dawkins CJM (1956) Relief of postoperative pain by continuous epidural drip. Proceedings of the 4th Congress Scandinavian Society of Anaesthesiologists, Helsinki, p 77
Griffiths DPG, Diamond AW, Cameron JD (1975) Postoperative extradural analgesia following thoracic surgery: a feasibility study. Br J Anaesth 47:48
Freund FG, Bonica JJ, Ward RJ, Akamatsu TJ, Kennedy WF (1967) Ventilatory reserve and level of motor block during high spinal and epidural anaesthesia. Anesthesiology 28:834
Takasaki M, Takahashi T (1980) Respiratory function during cervical and thoracic extradural analgesia in patients with normal lungs. Br J Anaesth 52:1271
Bonica JJ, Kennedy WF, Akamatsu TJ, Gerbershagen MU (1972) Circulatory effects of peridural block. III: Effects of acute blood loss. Anesthesiology 36:219
Lund PC (1962) Peridural Anesthesia: A review of 10,000 administrations. Acta Anaesth Scand 6:143
Spence AA, Smith G (1971) Postoperative analgesia and lung function: a comparison of morphine with extradural block. Br J Anaesth 43:144
Pflug AE, Murphy TM, Butler SH, Tucker GT (1974) The effects of postoperative peridural analgesia on pulmonary therapy and pulmonary complications. Anesthesiology 41:8
Carpintero JL, Diez AR, Elvira MJR, Benitez JA, Rielo AP (1980) Methods of management of flail chest. Intensive Care Med 6:217
McCleave DJ, Gilligan JE, Worthley LIG (1977) The role and function of an Australian intensive care unit. Crit Care Med 5:245
Simpson BR, Parkhouse J, Marshall R, Lambrechts W (1961) Extradural analgesia and the prevention of postoperative respiratory complications. Br J Anaesth 33:628
Editorial. Pain relief after thoractomy (1976) Lancet 1:576
Richardson JD, Adams L, Flint LM (1982) Selective management of flail chest and pulmonary contusion. Ann Surg 196:481
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Worthley, L.I.G. Thoracic epidural in the management of chest trauma. Intensive Care Med 11, 312–315 (1985). https://doi.org/10.1007/BF00273543
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DOI: https://doi.org/10.1007/BF00273543