The treatment of patients with multiple rib fractures using continuous thoracic epidural narcotic infusion.

The incidence of tracheostomy, length of intensive care unit (ICU) and total hospital stay, and duration of ventilatory support were evaluated prospectively in 28 patients who had multiple rib fractures. The patients were randomly divided into two groups: 13 patients were given standard morphine parenteral analgesia and constituted the control group (Group 1), and 15 patients had thoracic epidural catheter placement within 72 hours from the time of admission to the ICU (Group 2). Group 2 patients had less ventilator-dependent time compared with control patients (3.07 +/- 1.35 days vs. 18.23 +/- 8.12 days, p less than 0.05), less time in ICU (5.93 +/- 1.44 days vs. 18.69 +/- 5.25 days, p less than 0.02), and a shorter hospital stay (14.85 +/- 2.21 days vs. 47.69 +/- 14.67 days, p less than 0.03). Group 2 patients also had a lower incidence of tracheostomy versus control patients (6.7 +/- 6.7% vs. 38.5 +/- 14.0%, p less than 0.05). The authors believe that continuous thoracic epidural morphine analgesia may provide distinct pulmonary and economic advantages in patients with multiple rib fractures.