Korean J Thorac Cardiovasc Surg.  2011 Apr;44(2):178-182. 10.5090/kjtcs.2011.44.2.178.

Thoracic Epidural Anesthesia and Analgesia (TEA) in Patients with Rib Fractures

Affiliations
  • 1Department of Thoracic and Cardiovascular Surgery, Konyang University Hospital, Korea. csking1@konyang.ac.kr

Abstract

BACKGROUND
We analyzed the results of surgical reduction and fixation of ribs under thoracic epidural anesthesia and analgesia (TEA) in patients who had no more than 3 consecutive rib fractures with severe displacement to examine the clinical usefulness of this method.
MATERIALS AND METHODS
From May 2008 to March 2010, 35 patients underwent surgical reduction and fixation of ribs under TEA. We reviewed the indications for this technique, number of fixed ribs, combined surgical procedures for thoracic trauma, intraoperative cardiopulmonary events, postoperative complications, reestablishment of enteral nutrition, and ambulation.
RESULTS
The indications of TEA were malunion or nonunion of fractured ribs in 29 (82.9%; first operation) and incompletely ribs under previous general anesthesia in 6 (17.1%; second operation). The average number of fixed ribs per patient was 1.7 (range: 1~3). As a combined operation for thoracic trauma, 17 patients (48.6%) underwent removal of intrathoracic hematomas, and we performed repair of lung parenchyma (2), wedge resection of lung (1) for accompanying lung injury and pericardiostomy (1) for delayed hemopericardium. No patient had any intraoperative cardiopulmonary event nor did any need to switch to general anesthesia. We experienced 3 postoperative complications (8.6%): 2 extrapleural hematomas that spontaneously resolved without treatment and 1 wound infection treated with secondary closure of the wound. All patients reestablished oral feeding immediately after awakening and resumed walking ambulation the day after operation.
CONCLUSION
Thoracic epidural anesthesia and analgesia (TEA) may positively affect cardiopulmonary function in the perioperative period. Moreover, this technique leads to an earlier return of gastrointestinal function and early ambulation without severe postoperative complications, resulting in a shortened hospital stay and lowered costs.

Keyword

Trauma, blunt; Ribs; Anesthesia

MeSH Terms

Analgesia
Anesthesia
Anesthesia, Epidural
Anesthesia, General
Displacement (Psychology)
Early Ambulation
Enteral Nutrition
Hematoma
Humans
Length of Stay
Lung
Lung Injury
Pericardial Effusion
Pericardial Window Techniques
Perioperative Period
Postoperative Complications
Rib Fractures
Ribs
Tea
Walking
Wound Infection
Tea
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