Effect of analgesia on the changes in respiratory parameters in blunt chest injury with multiple rib fractures

Abstract

Background:Blunt chest injury with multiple rib fractures can result in such complications as pneumonia, atelectasis, bronchiectasis, empyema thoracis, acute respiratory distress syndrome, and prolonged Intensive Care Unit and hospital stay, with its concomitant mortality. These may be prevented or reduced by good analgesic therapy which is the subject of this study.Methods:This was a prospective study of effects of analgesia on changes in pulmonary functions of patients with traumatic multiple rib fractures resulting from blunt chest injury.Results:There were 64 adult patients who were studied with multiple rib fractures caused by blunt chest trauma. Of these patients, 54 (84.4%) were male and 10 (15.6%) were female. Motorcycle (popularly known as “okada”) and tricycle (popularly known as keke napep) accidents significantly accounted for the majority of the multiple rib fractures, that is, in 50 (78.1%) of the patients. Before analgesic administration, no patient had a normal respiratory rate, but at 1 h following the administration of analgesic, 21 (32.8%) of patients recorded normal respiratory rates and there was a significant reduction in the number (10.9% vs. 39.1%) of patients with respiratory rates >30 breaths/min. Before commencement of analgesic, no patient recorded up to 99% of oxygen saturation (SpO2) as measured by pulse oximeter, while 43.8% recorded SpO2 of 96%. This improved after 1 h of administration of analgesics to SpO2 of 100% in 18.8% of patients and 99% in 31.3% of patients and none recording SpO2 of < 97% (P = 0.006). Before analgesia, no patient was able to achieve peak expiratory flow rate (PEFR) value >100% of predicted while only 9 (14.1%) patients were able to achieve a PEFR value in the range of 91%–100% of predicted value. One hour after analgesia, a total of 6 (9.4%) patients were able to achieve PEFR values >100% predicted, while 35 (54.7%) patients achieved PEFR values in the range of 91%–100% predicted.Conclusion:Adequate analgesia is capable of reversing the negative effects of chest pain of traumatic multiple rib fractures on pulmonary function parameters through improvement in respiratory mechanics.

Using an incentive spirometer reduces pulmonary complications in patients with traumatic rib fractures: a randomized controlled trial

“…There were 36,966 (54.6%) male patients and 30,715 (45.4%) female patients. Ekpe and Eyo [29] reported that 84.4% of patients with traumatic rib fractures were male (54 of 64 patients). In 2017, accidents were the sixth leading cause of death in Taiwan.…”

Pectointercostal fascial plane block for rescue pain management of traumatic sternal fracture following inadequate thoracic epidural block: a case report

“…Adequate analgesia is paramount for the management of traumatic thoracic injury and mitigates the negative effects of chest wall pain on pulmonary function parameters [ 1 ]. Opioids are commonly used for pain control in trauma settings; however, complications such as oversedation, respiratory depression, delirium, bowel dysfunction and abuse potential are well known [ 2 ].…”

Analgesia Reverses Abnormal Lung Function Tests in Patients with Blunt Chest Injury

“…Intercostals nerve block and systemic analgesic form the second and third tiers of modalities of chest pain relief in traumatic rib fractures, and a recent study has re-validated the superiority of ICNB over systemic analgesic [9]. A related study has further shown the positive effect analgesic in other aspects of respiratory function in thoracic trauma patients [10].…”