Pain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society

  title={Pain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society},
  author={Samuel M. Galvagno and Charles E. Smith and Albert J. Varon and Erik A. Hasenboehler and Shahnaz Sultan and G. Shaefer and Kathleen B. To and Adam D. Fox and Darrell E R Alley and Michael Ditillo and Bellal A. Joseph and Bryce R. H. Robinson and Elliott R. Haut},
  journal={Journal of Trauma and Acute Care Surgery},
INTRODUCTION Thoracic trauma is the second most prevalent nonintentional injury in the United States and is associated with significant morbidity. Analgesia for blunt thoracic trauma was first addressed by the Eastern Association for the Surgery of Trauma (EAST) with a practice management guideline published in 2005. Since that time, it was hypothesized that there have been advances in the analgesic management for blunt thoracic trauma. As a result, updated guidelines for this topic using the… 
Current Review of Analgesia and Regional Anesthesia Practices for Rib Fracture and Chest Wall Trauma
This review is to illustrate the increasing value and options that are available to peri-operative teams when caring for patients with acute traumatic chest and thoracic injuries and the growing number of options to provide adequate analgesia in these patients.
Chest wall pain management after chest wall trauma
The clinical implication, adequacy and possible complications of different analgesic approaches commonly used in thoracic trauma management, such as epidural anesthesia, regional anesthesia, endovenous and intrathecal analgesia are detailed.
A Systematic Review Examining the Efficacy of Epidural Analgesia on Mortality in Older Adult Patients with Rib Fractures
This systematic review did not find any statistically significant data to suggest that mortality is decreased in older adults by utilizing epidural analgesia after thoracic trauma, and further research is necessary utilizing prospective data focusing on this particular patient population in order to better determine the effectiveness of this treatment.
Epidural Analgesia for Severe Chest Trauma: An Analysis of Current Practice on the Efficacy and Safety
Epidural analgesia was successful in 59% of patients; however, 30% needed additional analgesic interventions and about half of the patients had epidural-related complications, suggesting it remains debatable whether epidural morphine is a sufficient treatment modality in patients with multiple rib fractures.
Regional Anesthesia for Trauma in the Emergency Department
A multidisciplinary approach with emergency physicians, anesthesiologists, and trauma surgeons can help to continue a multimodal analgesic regimen with regional anesthesia for several days, and further research to identify safe and effective dosing of local anesthetics and the clinical impact of RA techniques for rib fractures in polytrauma patients in the ED is warranted.
Pain management in thoracic trauma.
The importance of good pain control in the management of thoracic trauma and the available evidence supporting the available modalities including nonpharmacological, pharmacological, regional analgesia, and surgical fixation are discussed.
Regional Anesthesia for the Acute Trauma Patient
This chapter reviews recent literature to describe the utility of regional analgesic techniques in the pre-hospital, emergency department, and perioperative management of acute pain in trauma to optimize patient safety and clinical outcome.
Early Use of a Chest Trauma Protocol in Elderly Patients with Rib Fractures Improves Pulmonary Outcomes
The chest trauma protocol has significantly decreased adverse pulmonary events in the older blunt chest trauma population with multiple rib fractures and has become the standard procedure for patients older than 45 years admitted with rib fractures.
Chest Trauma: Current Recommendations for Rib Fractures, Pneumothorax, and Other Injuries
Chest trauma is commonly encountered, and anesthesiologists have the potential to significantly improve morbidity and mortality in this group of patients.


The effect of epidural placement in patients after blunt thoracic trauma
In this multicenter study, epidural catheter placement was associated with a significantly decreased risk of dying in patients with blunt thoracic injury of three or more rib fractures, and trauma centers are more likely to place epiduralCatheter in patientsWith rib fractures.
Clinical management of blunt trauma patients with unilateral rib fractures: A randomized trial
The patients with IPCs statistically had more compromised pulmonary function as measured by forced vital capacity (FVC) on admission; however, they tended toward a greater objective improvement of FVC on discharge; and when analyzing a cohort of severely impaired patients, half of the systemic medication patients compared to only 10% of the IPC group failed and required another mode of therapy.
Effect of epidural analgesia in patients with traumatic rib fractures: a systematic review and meta-analysis of randomized controlled trials
No significant benefit of epidural analgesia on mortality, ICU and hospital LOS was observed compared to other analgesic modalities in adult patients with traumatic rib fractures, however, there may be a benefit on the duration of mechanical ventilation with the use of thoracic epidural morphine with local anesthetics.
Thoracic epidural analgesia versus intravenous patient-controlled analgesia for the treatment of rib fracture pain after motor vehicle crash.
Thoracic epidural analgesia with bupivacaine and fentanyl provided superior analgesia than intravenous patient-controlled analgesia morphine.
A stepwise logistic regression analysis of factors affecting morbidity and mortality after thoracic trauma: effect of epidural analgesia.
Epidural analgesia has a positive effect on outcome in elderly trauma victims with chest wall injury and is useful in high-risk patients, and increased costs associated with epidural analgesIA are minimal and are justified by improvements in outcome.
The Eastern Association of the Surgery of Trauma approach to practice management guideline development using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology
The purpose of this article was to describe the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.
Epidural Analgesia after Rib Fractures
The epidural cohort had longer hospital LOS and decreased mortality, and DVT rates were increased in patients who received epidural catheters, in contrast to other studies.
A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management.
  • M. Sırmalı, H. Türüt, I. Taştepe
  • Medicine
    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
  • 2003