Abstract ID: A9
Abstract Title: Indications and Contraindication for Epidural Analgesia in Multiply injured Patients
Authors: Bulger E1, Edwards W2, Klotz P3, Jurkovich G4
University of Washington Seattle WA USA1, University of Washington Seattle WA USA2, University of Washington Seattle WA USA3, University of Washington Seattle WA USA4
Poster Type: Poster
ABSTRACT BODY
Introduction:Rib fractures have been associated with significant morbidity and mortality following traumatic injury. We have recently reported a significant reduction in pneumonia and duration of mechanical ventilation for patients randomized to receive epidural analgesia (EA) following multiple rib fractures (Bulger EM, Edwards T, Klotz P, Jurkovich GJ. Epidural analgesia improves outcome following multiple rib fractures. Surgery,2004, 136:426-30.). There remains controversy, however, regarding the appropriate indications and contraindications for EA in multiply injured patients. We sought to determine the parameters of this current practice among Level 1 trauma centers.
Materials and Methods: A survey was sent to the directors of pain management services at all COT designated Level I trauma centers in the U.S. The survey queried their opinion regarding the appropriateness of 33 contraindications and 8 indications for EA after rib fractures.
Results: Responses were received from 81/188 (43%)Level 1 USA trauma centers. 95% of respondents indicated that EA is used after rib fractures, but only 15% had guidelines defining the indications and contraindications. There was substantial agreement (>80%) regarding the indications for EA but disagreement regarding the contraindications.
Discussion:These data support the need to develop evidence-based guidelines and practice parameters to support the use of EA in the multiply injured patient.
ATTACHED FILES
Reg Anesth Pain Med 2005; 30(3):A9