CLINICAL MANAGEMENT OF BLUNT TRAUMA PATIENTS WITH UNILATERAL RIB FRACTURES - A RANDOMIZED TRIAL

Optimal pain management is essential in blunt trauma patients sustaini ng significant chest trauma. The purpose of this randomized prospectiv e trial was to measure the difference in pulmonary function in nonintu bated patients with unilateral multiple rib fractures receiving two mo dalities of pain relief: systemic narcotic medications alone or local anesthetics given by intrapleural catheter (IPCs), Forty-two patients were randomized to receive systemic narcotic medications or IPCs for p ain control. The patients with IPCs statistically had more compromised pulmonary function as measured by forced vital capacity (FVC) on admi ssion; however, they tended toward a greater objective improvement of FVC on discharge. When analyzing a cohort of severely impaired patient s (initial FVC < 20%), half of the systemic medication patients compar ed to only 10% of the IPC group failed and required another mode of th erapy. Catheter complications were minor and did not contribute to ove rall morbidity. The IPC patients had fewer failures than the systemic medication patients.