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Table 2 Pain management and use of epidural analgesia

From: Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements

  No epidural analgesia (N = 658) Epidural analgesia (N = 130) P value
Baseline characteristics
 Age, years, mean ± SD 55 ± 17a 57 ± 16b 0.15
 History of chronic respiratory disease, n (%) 83/653 (12.7%) 14/130 (10.8%) 0.54
 History of alcoholism, n (%) 105/640 (16.4%) 26/123 (21.1%) 0.20
 History of smoking, n (%) 227/633 (35.9%) 44/123 (35.8%) 0.98
 Obesity (BMI ≥ 30), n (%) 83/648 (12.8%) 25/126 (19.8%) 0.04
 Number of fractured ribs ≥ 6, n (%) 312/656 (47.6%) 87/129 (67.4%) < 0.0001
 Flail chest, n (%) 143/648 (22.1%) 57/129 (44.2%) < 0.0001
 Thoracic AIS (mean ± SD) 3.46 ± 0.61 3.75 ± 0.53 < 0.0001
 Injury Severity Score, mean ± SD 17.5 ± 7.0 20.2 ± 7.0 0.0001
 SAPS II, mean ± SD 21 ± 10c 21 ± 9d 0.46
Clinical variables at ICU admission
 Oxygen saturation, %, mean ± SD 96 ± 5e 96 ± 3f 0.81
 Respiratory rate, breaths/min, mean ± SD 20 ± 5 g 20 ± 5 h 0.87
 Oxygen flow > 6 L/min, n (%) 117/649 (18.0%) 37/127 (29.1%) 0.004
 History of alcoholism
  No 535i 97j 0.41
  Yes, without symptoms of withdrawal 80 19  
  Yes, with symptoms of withdrawal 25 7  
Outcomes
 Median NRS pain score on day 1 > 4, n (%) 243/637 (38.1%) 60/125 (48.0%) 0.04
 Maximum NRS pain score from day 1 to day 4, median [IQR] 6 [5.0–8.0] 7 [5.0–8.0] 0.03
Median numerical rating scale pain score, median [IQR]
 Day 1 3.0 [1.0–5.0]k 3.5 [1.0–5.0]l 0.23
 Day 2 2.5 [1.0–4.0]k 2.5 [0.5–4.0]l 0.37
 Day 3 2.0 [0.0–4.0]k 2.0 [0.0–3.0]l 0.49
 Day 4 2.0 [0.0–3.5]k 1.0 [0.0–3.0]l 0.01
 Day 5 2.0 [0.0–3.5]k 1.0 [0.0–3.0]l 0.09
 Day 6 2.0 [0.0–3.0]k 2.0 [0.0–3.0]l 0.36
 Day 7 1.5 [0.0–3.0]k 2.0 [0.0–3.5]l 0.64
Intravenous morphine
 Day 1, n (%) 395/657 (60.1%) 76/130 (58.5%) 0.72
 Dose during the first 24 h in the ICU, mg, median [IQR] 5 [0–16]m 5.0 [0.0–14]n 0.78
 Day 7, n (%) 62/657 (9.4%) 27/130 (20.8%) 0.0002
Other analgesics during the first 7 ICU days, n (%)
 NSAIDs 186/629 (29.6%) 42/129 (32.6%) 0.50
 Ketamine 63/625 (10.1%) 18/127 (14.2%) 0.17
 Nefopam 478/639 (74.8%) 96/128 (75.0%) 0.96
 Paracetamol 625/654 (95.6%) 124/129 (96.1%) 0.78
 Tramadol 361/633 (57.0%) 69/129 (53.5%) 0.46
 Intercostal anesthesia 18/658 (2.1%)   
  Days with intercostal anesthesia, median [IQR] 4 [3–5.5]   
Epidural analgesia
 Patients with EA, n (%)   130/788 (16.5%)  
 Time from hospital admission to EA, days, median [IQR]   1 [0–2]  
 Time from ICU admission to EA, days, median [IQR]   1 [0–2]  
 EA duration, days, mean ± SD   4.1 ± 2.2o  
 Local anesthetics, n (%)
  Ropivacaine   118/124 (95.2%)  
  Bupivacaine   0/124 (0%)  
  Levobupivacaine   6/124 (4.8%)  
 Local opioids, n (%)
  Sufentanil   96/125 (76.8%)  
  Morphine   7/125 (5.6%)  
  None   22/125 (17.6%)  
 Complications, n (%)
  Epidural hematoma   0  
  Epidural abscess   0  
  Severe hypotension   1  
 No pain relief from EA, n (%)   5/111 (4.5%)  
Mechanical ventilation
 IMV, n (%) 53/658 (8.0%) 12/130 (9.2%) 0.65
  Time from ICU admission to IMV, days, median [IQR] 2 [1–4]p 2.5 [1.5–5]q 0.52
  IMV duration, days, median [IQR] 9.5 [5–16]p 10 [4.5–13]q 0.97
  Reason of IMV initiation (more than one possible for each patient)
   Acute respiratory failure 51 10 0.15
   Acute neurologic failure 6 3 0.35
   Acute circulatory failure 3 1 0.57
 Noninvasive ventilation, n (%) 146/647 (22.6%) 58/129 (45.0%) < 0.0001
 ICU stay length, days, median [IQR] 5 [2–8]r 8 [6–12] < 0.0001
 Hospital stay length, days, median [IQR] 10 [6–17]s 13 [9–18]t 0.0002
 ICU mortality, n (%) 13/653 (2.0%) 5/129 (3.9%) 0.20
 Hospital mortality, n (%) 15/650 (2.3%) 5/127(3.9%) 0.35
  1. Where the available number of patients with data is not specified, all patients in the group had available data
  2. BMI body mass index, NRS numerical rating scale, IQR interquartile range, AIS Abbreviated Injury Scale, ISS Injury Severity Score, SAPS II Simplified Acute Physiology Score version II, NSAIDs nonsteroidal anti-inflammatory drugs, EA epidural analgesia, IMV invasive mechanical ventilation
  3. a Available for 652/658 patients
  4. b Available for 128/130 patients
  5. c Available for 646/658 patients
  6. d Available for 124/130 patients
  7. e Available for 650/658 patients
  8. f Available for 128/130 patients
  9. g Available for 635/658 patients
  10. h Available for 123/130 patients
  11. i Available for 622/658 patients
  12. j Available for 116/130 patients
  13. k Available on days 1 through 7 for 637, 598, 505, 408, 300, 232, and 170 patients, respectively
  14. l Available on days 1 through 7 for 125, 123, 121, 116, 105, 96, and 71 patients, respectively
  15. m Available for 642/658 patients
  16. n Available for 129/130 patients
  17. o Available for 129/130 patients
  18. p Available for 52/53 patients
  19. q Available for 12/12 patients
  20. r Available for 654/658 patients
  21. s Available for 650/658 patients
  22. t Available for 128/130 patients