The Treatment of Rib Fractures with Thoracic Epidural Analgesia

Rib fractures are detected in nearly 300,000 patients admitted to U.S. trauma centers each year. Among these patients, a mortality rate of about 10% can be expected. It is often pain, rather than structural damage, that precipitates the high risk of mortality. Focusing rib fracture care on effective pain management improves treatment outcomes. The purpose of this investigation was to explore the efficacy and cost-effectiveness of one mode of pain management - thoracic epidural analgesia (TEA) - in the treatment of patients with rib fractures. Methods: Four years of patient records were obtained from a Level II trauma center in an urban-suburban setting. There were 1,008 patients with ≥ 1 fractured rib in the registry. These patients were retrospectively analyzed, evaluating relationships between TEA and mortality, risk of complications, use of mechanical ventilation, length of stay in the hospital and intensive care unit, and total treatment cost. Results: The severity of injuries among patients receiving TEA was significantly worse, but there was no significant difference in mortality between patients treated with TEA (0.6%) and those receiving alternative treatments (2.0%; p=0.233). There was a trend that the administration of TEA decreased odds of mortality by 87% (p=0.071). Similarly, the use of TEA predicted a $12k reduction in total patient charges (