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Comparative Analysis of the Paravertebral Analgesic Pump Catheter with the Epidural Catheter in Elderly Trauma Patients with Multiple Rib Fractures.

Abstract Presently, trauma guidelines recommend epidural analgesia as the optimal modality of pain relief from rib fractures. They are not ideally suited for elderly trauma patients and have disadvantages including bleeding risk. The paravertebral analgesic pump (PVP) eliminates such disadvantages and includes ease of placement in the trauma setting. This study compares pain control in patients treated by EPI versus PVP. This is a retrospective, historical cohort study comparing two methods of pain management in the trauma setting. Before 2010, patients who had epidural catheters (EPI) placed for pain control were compared with patients after 2010 in which the PVP was used. All patients had multiple rib fractures as diagnosed by CT scan. Analysis was adjusted for age, number of fractures, and comorbid conditions. Multiple linear regression analysis was conducted to compare average reported pain. A total of 110 patients, 31 PVP and 79 epidural catheters, were included in the study. Overall mean age was 65 years. The mean Injury Severity Score was 12.0 (EPI) and 11.1 (PVP). Mean number rib fractures was 4.29 (EPI) and 4.71 (PVP). PVP was associated with a 30 per cent greater decrease in pain than that seen with EPI (6.0-1.9 vs 6.4-3.4). After controlling for age, Injury Severity Score, and number of rib fractures, there were no differences in intensive care unit or total length of stay (P = 0.35) or in pain score (3.76 vs 3.56, P = 0.64). In conclusion, the PVP compares well with epidural analgesia in older trauma patients yet is safe, well tolerated, and easily inserted.
PMID
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Authors

Mayor MeshTerms

Catheterization

Keywords
Journal Title the american surgeon
Publication Year Start




PMID- 28424138
OWN - NLM
STAT- MEDLINE
DA  - 20170420
DCOM- 20170501
LR  - 20170501
IS  - 1555-9823 (Electronic)
IS  - 0003-1348 (Linking)
VI  - 83
IP  - 4
DP  - 2017 Apr 01
TI  - Comparative Analysis of the Paravertebral Analgesic Pump Catheter with the
      Epidural Catheter in Elderly Trauma Patients with Multiple Rib Fractures.
PG  - 399-402
AB  - Presently, trauma guidelines recommend epidural analgesia as the optimal modality
      of pain relief from rib fractures. They are not ideally suited for elderly trauma
      patients and have disadvantages including bleeding risk. The paravertebral
      analgesic pump (PVP) eliminates such disadvantages and includes ease of placement
      in the trauma setting. This study compares pain control in patients treated by
      EPI versus PVP. This is a retrospective, historical cohort study comparing two
      methods of pain management in the trauma setting. Before 2010, patients who had
      epidural catheters (EPI) placed for pain control were compared with patients
      after 2010 in which the PVP was used. All patients had multiple rib fractures as 
      diagnosed by CT scan. Analysis was adjusted for age, number of fractures, and
      comorbid conditions. Multiple linear regression analysis was conducted to compare
      average reported pain. A total of 110 patients, 31 PVP and 79 epidural catheters,
      were included in the study. Overall mean age was 65 years. The mean Injury
      Severity Score was 12.0 (EPI) and 11.1 (PVP). Mean number rib fractures was 4.29 
      (EPI) and 4.71 (PVP). PVP was associated with a 30 per cent greater decrease in
      pain than that seen with EPI (6.0-1.9 vs 6.4-3.4). After controlling for age,
      Injury Severity Score, and number of rib fractures, there were no differences in 
      intensive care unit or total length of stay (P = 0.35) or in pain score (3.76 vs 
      3.56, P = 0.64). In conclusion, the PVP compares well with epidural analgesia in 
      older trauma patients yet is safe, well tolerated, and easily inserted.
FAU - Shapiro, Brian S
AU  - Shapiro BS
FAU - Wasfie, Tarik
AU  - Wasfie T
FAU - Chadwick, Mathew
AU  - Chadwick M
FAU - Barber, Kimberly R
AU  - Barber KR
FAU - Yapchai, Raquel
AU  - Yapchai R
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
RN  - 0 (Analgesics)
SB  - IM
MH  - Aged
MH  - Analgesia/*instrumentation
MH  - Analgesia, Epidural/*methods
MH  - Analgesics/*administration & dosage
MH  - *Catheterization
MH  - Comorbidity
MH  - Female
MH  - Humans
MH  - Injury Severity Score
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Pain Management/*methods
MH  - Pain Measurement
MH  - Retrospective Studies
MH  - Rib Fractures/*complications/diagnostic imaging
MH  - Tomography, X-Ray Computed
MH  - Treatment Outcome
EDAT- 2017/04/21 06:00
MHDA- 2017/05/02 06:00
CRDT- 2017/04/21 06:00
PST - ppublish
SO  - Am Surg. 2017 Apr 1;83(4):399-402.

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