Table 2 Pain management and use of epidural analgesia
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 |