TITLE:
Thoracic Epidural Analgesia versus Dexmedetomidine Infusion in Traumatic Flail Chest
AUTHORS:
Ahmed Abdelaal Ahmed Mahmoud, Mohamed Adly Elramely, Hatem Elmoutaz
KEYWORDS:
Dexmedetomidine, Thoracicepidural, Flail Chest
JOURNAL NAME:
Pain Studies and Treatment,
Vol.4 No.2,
April
27,
2016
ABSTRACT: Background: Traumatic flail chest is a serious injury that can impair ventilation and affect patient outcome. Thoracic epidural analgesia is the gold standard to provide adequate analgesia in flail chest, however, it may be unavailable in some patients due to coagulopathy, failure or difficult insertion. We compared between parenteral dexmedetomidine and thoracic epidural block with plain local anesthetic in flail chest cases. Patients and methods: fifty eight trauma patients with flail chest randomly allocated into either Group E (n = 29): epidural group, patients received mid-thoracic epidural analgesia using 6 ml mixture of 0.125% bupivacaine and 2 μg/ml fentanyl, which followed by continuous infusion of 6 ml/hour; Group D (n = 29): dexmedetomidine group, patients received loading dose of dexmedetomidine 1 μg/kg over 30 min, after a continuous infusion at a rate of 0.5 μg/kg/hr. The primary outcomes were to assess the effect of analgesic type on ventilation (PaO2/FIO2 ratio, PaCO2). The secondary outcomes were to compare analgesic effect, hemodynamics, the need for ventilation and ICU stay. Result: PaO2/FIO2 ratio was significantly higher in epidural group and PaCO2 was significantly lower in epidural group (p value