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SHOULD THORACIC EPIDURALS BE USED AS A GOLD STANDARD FOR MANAGEMENT OF MAJOR CHEST TRAUMA AT A TERTIARY TRAUMA CENTRE IN LONDON?
Author(s): ,
Sodhi, H.*
Affiliations:
Kings Trauma Centre- Kings College Hospital, Anaesthetics and Critical care, London, United Kingdom
,
Shammas, K.
Affiliations:
Kings Trauma Centre- Kings College Hospital, Anaesthetics and Critical care, London, United Kingdom
Bloomer, R.
Affiliations:
Kings Trauma Centre- Kings College Hospital, Anaesthetics and Critical care, London, United Kingdom
ESRA Academy. Sodhi H. Sep 13, 2017; 190756; 406 Topic: Epidural Anaesthesia - Analgesia
Dr. Harpreet Sodhi
Dr. Harpreet Sodhi

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Abstract
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Background and Aims:

In Europe, chest trauma contributes to 10% of all trauma related deaths and pain may be difficult to manage in survivors.

Studies have shown that thoracic epidural (TE) analgesia may prevent morbidity secondary to hypoventilation associated with pain.

We aim to show that a standard operating procedure and protocol guided care is needed to manage major chest trauma.


Methods:

Retrospective study into the use of thoracic epidurals in chest trauma.

TARN – Trauma Audit Research Network searched over a 6-month period : 1st January to 1st July 2015.

147 patients had associated chest trauma suitable for study.

Results:

The pain team was involved in the management of all 19 patients who received Epidurals.

8 epidurals were sited as a primary mode of analgesia and 11 secondarily as PCA analgesia had failed.

There were 17 cases were analgesia was inadequate but 6 patients were suitable for thoracic epidural.

2 of 6 patients developed respiratory failure and had no significant past medical history.

Patients who were considered unfit for epidurals due to anticoagulation developed respiratory failure.

   

Conclusions:

Non-epidural analgesic failure corresponded to advancing age, increasing number of rib fractures and bilateral involvement.

We make the argument that by providing early thoracic epidural analgesia the trade-off between analgesia and narcosis is minimized.

The need for analgesia in anticoagulation patients should not be undermined and other options explored. 

We proposed a new guideline for the management of patients at high risk of analgesic and respiratory failure even when thoracic epidural is contraindicated, by using other regional anaesthetic techniques like serratus plane blocks.

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