engleski

The influence of early continous epidural analgesia on haemodynamic changes in elderly trauma patients with several pelvic fracture

Continous epidural analgesia improves excellent pain control in trauma patients with multiple pelvic fractures. Residual hemodynamic instability followed by retroperitoneal hemorrhagie in the first 48 hours often post-pones its application with need for parenteral use of high dose of opioids. The aim was to detect the influence of early continous epidural analgesia (after first 24 hours) on hemodinamic changes in these trauma patients. Fifty trauma patients with multiple pelvic fractures were divided in two equal groups and included in prospective, randomized study during six months period. In bought groups initial analgesia was started with sufentanil 10 ucg/h in the first 24h. In Group EP continous epidural analgesia (levibupivacain O.125%, 5-7 ml/h) was started after 24h. In Group O continous infusion of opioid (sufentanil 5-10 ucg/h) was followed. The titration dose of analgetics in the bought groups following the VAS score under 3. PICCO monitoring was establisch in all patients. MAP, CI, heart rate, SVRI, ITBWI and ETBWI was measured during five days. The study groups were comparabile in demographic data. Under first 24 hours in bought groups were the high need for fluid replacement (ETBWI less than 10). In Group EP SVRI was less (800-1000) after epididural analgesia and recovered with 500-750 ml of kristaloids. ITBWI was stastistical more stable in Group EP (850) to compare Group O (950-1000). Early continous epidural analgesia with 0.125% levibupivacain is safe as continous opioid analgesia in trauma patients with multiple pelvic fractures but without opioids complications.

pelvic fracture; epidural analgesia; hemodynamic changes; eldery

DOI: 10.1111/j.1533-2500.2009.00267.x