Intrapleural versus epidural analgesia with local anesthetics in patients with thoracic trauma
© BioMed Central Ltd. 2004
Published: 15 March 2004
This prospective, randomized and controlled study aimed to compare the efficacy of two methods for analgesia in patients with chest trauma and rib fractures: continuous epidural catheter analgesia and regional intrapleural analgesia (RIPA). Seventy-three patients with unilateral chest trauma were randomized into two groups. In Group 1 patients we placed an epidural catheter (level – TH 8–10), and in Group 2 patients we placed an intrapleural catheter (level – fifth intercostal space). We used 1% lidocain for analgesia in both groups. The control group received intravenous analgesia with opioid. We applied 10 ml lidocain bolus to the intrapleural catheter four to six times per 24 hours and clamped the catheter for 10 min. For epidural analgesia we applied 50–100 mg lidocain and started continuous infusion at a rate of 2–3 mg/kg/hour, not exceeding a dose 400 mg lidocain per 24 hours. We monitored the level of thermohipanesthesia, the level of analgesia (Visual Aanalogue Scale – 10 points), parameters of respiratory and cardiovascular function (respiratory rate, arterial O2 oxygen saturation [SaO2], heart rate, arterial blood pressure, central venous pressure, ability to expectorate). Thermohipanesthesia was unilateral and significantly shorter in Group 2 patients, whereas in Group 1 patients it was bilateral and of longer duration. The level of analgesia was similar in both groups (0–4 points) but in Group 2 patients it was achieved by more frequent applications of lidocain, which potentially is dangerous for toxicity. The respiratory rate decreased, O2 and SaO2 increased, and the ability to expectorate was improved. In Group 2 patients the heart rate and arterial blood pressure remained stable, and in Group 1 patients there were episodes of tachycardia and hypotension, which is undesirable in trauma patients. The technique of placing an intrapleural catheter is easier.
RIPA is an acceptable alternative to epidural analgesia in patients with thoracic trauma.