Thoracic epidural in the management of chest trauma

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.