Introduction The adequate management of thoracic
trauma requires a systematic approach including
pain control,
respiratory therapy, and mobility achieved by surgical fixation. Failure to achieve
pain control prolongs
hospital stay. There are several options for achieving
analgesia including epidural
catheters, intravenous
narcotics, intercostal, paravertebral or interpleural blocks, oral
opioids, or simply a combination of the aforementioned interventions. In this study, we aim to compare the efficacy of thoracic
epidural analgesia with systemic
analgesia in patients with
polytrauma. Methods This prospective study was conducted in the intensive care unit (ICU) of District Headquarters Hospital in Dera Ghazi Khan, Pakistan. Patients of age ≥18 years with skeletal
trauma -
rib fractures, limb fractures, and pelvic fractures - were included in the study. Group A patients were given epidural -
bupivacaine and
tramadol. Group B patients were given systemic
analgesia with intravenous
opioids. The severity of
pain was assessed on the visual analogue scale (VAS) at time 0, 24 hours, and 48 hours. Data was entered and analysis was performed using Statistical Package for Social Sciences version 22.0. Results At 24 hours and 48 hours interval, group A showed a lower mean VAS score than group B (p = 0.74; p = 0.03). Group A required lesser mean doses of additional
short-acting analgesics than group B (4.87 ± 1.06 vs. 6.77 ± 1.44; p < 0.0001). In Group A, 94% were discharged and the mortality rate was 6%; in group B, 86% were discharged and the mortality rate was 14% (p = 0.21). Conclusion
Epidural analgesia provides better
pain relief and requires fewer short-acting supplementing
analgesics as compared to systemic
analgesia in patients with multi-
trauma.