Comparative Study of Triamcinolone Versus Morphine Effectiveness in Thoracic Epidural Analgesia for Rib Fracture Pain

Background: Thoracic epidural analgesia continues to be an indispensable element of acute pain management that are predicated by anesthesia. It is employed to alleviate acute pain following rib fractures and thoracic and abdominal surgeries. The objective of this research was to evaluate the analgesic efficacy of morphine and thoracic epidural triamcinolone acetonide in the context of fractured chest. Methods: This prospective randomized comparative study involved 40 adults suffering from multiple fractured ribs among those presenting to Trauma Unit in Assiut University Hospital. Two equal groups of patients were randomly designated: Group (M) (Morphine group): was administered a combination of 9 ml of bupivacaine 0.25 % and 0.1mg/kg morphine, and group (S) (Steroid group): was administered a combination of 9 ml of bupivacaine 0.25 % and 80 mg of triamcinolone acetonide. All patients underwent routine investigations including coagulation studies and computed tomography and chest x-ray. Results: There was a significantly higher visual analogue scale coughing scale in the steroid group during the follow-up starting from the 6th hour up to the 42nd hour. Group M had signifcinatly higher prevalence of nausea and vomiting than group S. The need for nonsteroidal anti-inflammatory drugs (NSAIDs) was significantly higher in the steroid group. Conclusions: Epidural morphine can afford a better quality of pain alleviation than triamcinolone acetonide; however, it is not devoid of some respiratory complications in traumatic rib(s) fracture.