Thoracic Epidural Analgesia, Fracture Ribs Clinical Trial
Official title:
Comparative Study of Magnesium Sulfate Versus Fentanyl as Adjuvants to Bupivacaine for Thoracic Epidural Analgesia in Multiple Traumatic Fracture Ribs
This work aims at comparing the analgesic effect of Thoracic Epidural Magnesium sulfate versus Fentanyl when added as adjuvants to Bupivacaine in patients with multiple traumatic fracture ribs.
Rib fractures are a common condition following trauma with a reported incidence of up to 10%
in trauma in general, and up to 39% in blunt chest trauma. Traumatic rib fractures are
associated with significant morbidity and mortality, and mortality rates reaching 10-16% has
been reported. An estimated one third of patients with traumatic rib fractures develop
secondary pulmonary complications with an associated mortality rate as high as 65% . Pain is
recognized as a contributing factor to adverse outcome in traumatic rib fractures due to
pain-induced inadequate respiratory efforts leading to atelectasis, difficulties in clearing
secretions and an increased risk of developing pneumonia. Consequently, adequate analgesia is
considered a core intervention in the management of patients with traumatic rib fractures.
There are a variety of ways to manage a patient's pain. Oral analgesic drugs and regional
modes are more likely to be used .
Regional analgesia is often supplemented with a small dose of either NSAIDs or opioids and
pain reduction is typically strong and immediate. There is little sedation, so evaluation of
head and abdominal injuries is easier. A major disadvantage is the technical complexity of
the procedures, leading to occasional errors in the administering of the treatments. They can
also be painful while the needle is entering (or catheter is being installed), toxicity is a
possibility, and the patients require more intensive monitoring and care by the physicians
and nurses. There are a variety of modes; the four most common are TEA, thoracic
paravertebral block, intercostal block, and intrapleural block. This study focuses on
thoracic epidural analgesia.
Narcotic infusions and continuous local anesthetic can be delivered through thoracic or
lumbar epidural catheters. Opioid receptors exist in the spinal cord that can alter the
perception of pain without needing stimulation of receptors in the brain. After inserting the
catheter into this area, local anesthetics and narcotics are administered, blocking the
anterior and posterior nerve roots crossing this space. The anesthetic/analgesic agents
diffuse across the dura and begin to block sensory nerves. Motor nerves are affected to a
lesser degree. It takes a large dose to achieve the desired effect.
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