What is the role of epidural analgesia in the treatment of rib fractures?

Updated: Jun 13, 2017
  • Author: Sarah L Melendez, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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A meta-analysis that included 8 studies (232 patients) did not demonstrate significant benefit of epidural analgesia on mortality, ICU, and hospital length of stay compared with other analgesic modalities in adult patients with traumatic rib fractures. Mechanical ventilation with the use of thoracic epidural analgesia with local anesthetics may be beneficial, although hypotension was significantly associated with thoracic epidural analgesia. Further research and evaluation is needed regarding the benefits and harms of epidural analgesia in this population before being considered as a standard of care therapy. [49]

In a study of epidural analgesia versus paravertebral block for patients with rib fractures using information from the National Trauma Data Bank, neither procedure was found to be more beneficial; however, in patients who did not undergo either procedure, mortality was increased (odds ratio 2.25; 95% confidence interval, 1.14-3.84; P=.002). [42]

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