Prospective evaluation of epidural versus intrapleural catheters for analgesia in chest wall trauma

Severe blunt chest trauma can produce multiple rib fractures, flail segments, and pulmonary contusions. All of these injuries produce pain and diminished pulmonary function. The effectiveness of intrapleural and epidural administration of bupivacaine was prospectively evaluated in 19 patients with severe chest trauma. Pain relief and pulmonary function were evaluated for 72 hours after catheter placement. Epidural administration of bupivacaine significantly reduced pain at rest and with motion compared with the intrapleural route (p < 0.05). Parenteral narcotic use was also significantly less in the epidural group (p < 0.05). Negative inspiratory pressure and tidal volume were significantly increased with epidural anesthesia (p < 0.05). Vital capacity, FIO2, minute ventilation, and respiratory rate were not affected. Mild hypotension was a common complication with epidural catheters. We conclude that continuous epidural analgesia is superior to intrapleural block and significantly improves tidal volume and negative inspiratory pressure.