Thoracic epidural analgesia vs. intravenous analgesia in blunt thoracic trauma patients, managed conservatively with noninvasive ventilation (NIV): A prospective observational study

Background: Most of the previous studies comparing epidural analgesia (EA) with intravenous (i.v.) analgesia in blunt trauma chest (BTC) patients are retrospective in nature. This prospective, observational study was done to evaluate the effect of EA with i.v. analgesia in BTC patients who were managed by noninvasive ventilation (NIV). Aim: The aim of this study was to compare the effect of EA with i.v. analgesia in BTC patients managed conservatively with NIV and to compare the length of intensive care unit (ICU) stay. Settings and Design: A prospective observational study was conducted in tertiary-level ICU patients. Materials and Methods: Adult patients of BTC neither requiring surgery nor invasive mechanical ventilation were included. Patients with contraindication to NIV or EA were excluded. Forty-six patients were divided into two groups. One group received EA and other i.v. analgesia. Oxygenation and pain relief were compared in terms of PaO2/FiO2 ratio and Visual Analog Scale (VAS), respectively. Statistical Analysis: Result interpretation was done using the Student’s t-test and Chi-squire test. Results: At 36 h after EA and thereafter up to 72 h, there was significant difference in P/F ratio. Better oxygenation was noted in EA group. Patient’s VAS scoring shows significantly low (P < 0.001) in patients receiving EA after 1 h. Mean ICU stay in EA and i.v. group was 10.17 ± 4.697 and 13.83 ± 4.96 days, respectively (P = 0.013). Conclusions: EA provides excellent pain relief as compared to i.v. analgesia, which results in improved respiratory exchange, effective coughing, better secretions clearance, and higher P/F ratio. ICU stay was significantly lower in patients receiving EA.