The effect of Intrapleural analgesia in patients operated for flail chest

Objective: Chest wall injury is an extremely common following blunt trauma. It varies in severity from minor bruising or an isolated rib fracture to server crush injuries. About 10% of adult patients in high-energy trauma sustain multiple rib fractures. Some of these patients suffer from flail chest leading to respiratory insufficiency. IPA administration is one of the different methods for providing perioperative analgesia in various upper abdominal surgeries like cholecystectomy, renal surgery and breast surgery. As well as providing analgesia for non-surgical conditions like fractured ribs, cancer pain, herpes pain and pancreatic pain. Methods: Patients and Methods: In a prospective manner, we randomized all patients admitted between September 2010 and July 2014, with flail chest requiring surgery in this trial. We found 36 patients. Group A consist of 5 women and 13 man and Group B 6 woman and 12man With an age between 19-86 years (mean 59). The mean Injury Severity Score (ISS) was 21.7 (SD +−10.8) in 36 patients. 11women and 25 of 36 patients with IPA catheters, Almost all of our patients also received EDA by anesthesiologists before thoracotomy. Tab-1&2 Intrapleural infiltration started in the trauma bayaccording to the written routine. They received intrapleural 40 mL of 0.25% bupivacaine, Postoperative pain was evaluated using a visual analog scale (VAS). Pulse oximetry for saturation, heart rate, and systemic arterial pressures were monitored. All observations were recorded, 30,60, 120 and 360 minutes after the injection, and thereafter every 3 hours, intervals through the postoperative 36 hours. Tab-3&4 Results: Intrapleural bupivacaine does not increase the respiratory depression risk that is often associated with opioids, comparing of groups A and B, our patients in group B got more complication in form of arrhythmia, Headache, Nausea, Urinary, retention, Hypotension than group A. Conclusions: Intrapleural bupivacaine can be a suitable pain management option for thoracic surgeries (flail chest surgery) without EDA Complications. IPA is an easy technique; somatic and visceral anesthesia may be achieved by injecting local anesthetics in the intrapleural space. The easy placement of an intrapleural catheter and better pain relief observed in the present study suggest that intermittent pleural infusion of 0.25% bupivacaine has proven to be a safe and effective method for relief of post-thoracotomy pain.