engleski

Comparation of early continuous epidural and intravenous opioid analgesia on haemodinamic changes after several pelvic fractures

Background and Purpose: Continuous epidural analgesia improves excellent pain control in trauma patients with multiple pelvic fractures. Residual haemodynamic instability followed by retroperitoneal hemorrhagie in the first 48 hours often post-pones its applicationwith need for parenteral use of high dose of opioids. The aim was to compere the influence of early continuous epidural and intravenous opioid analgesia on haemodynamic changes in these patients. Materials and Methods: After Ethic Committee approval, fifty trauma patients with isolated multiple pelvic fractures were divided in two equal groups and included in prospective, randomized study. In bought groups initial analgesia was started with sufentanil 10 mg h–1 in the first 24h. After that, in Group EP continuous epidural analgesia (levibupivacain O.125%, 5–7 mL h–1) and in Group O continuous infusion of opioid (sufentanil 5–10 mg h–1) was started. The analgesics dose was titrated following the VAS score under 3. PICCO monitoring was established. MAP, CI, HR, SVRI, ITBVI and ELWI was measured during four days. Statistic analysis was done by SPSS 11.0. Results: Study groups were statistic comparable. In the first 24 hours during continuous opioid anaesthesia, bought groups had high need for fluid replacement (Group EP=3.2 ± 0.3, Group O=3.0 ± 0.5 L/24h) (P= 0.0928). Second day, SVRI was lower in O Group (1300–1520 ; EP Group=1700– 1810)(P=0.0243) and recovered with 500–750mLof crystalloids. ITBVI was statistical more stable in Group EP (870 ± 50 ; Group O (940 ± 90) (P=0.0002). Only 10% of patients with low CI (<3.0) in Group EP (Group O=32%) needed catecholamin support. Conclusion: Early continuous epidural analgesia with 0.125% levibupivacain is safe as continuous opioid analgesia in patients with multiple pelvic fractures but without opioids complications and better haemodynamic stability.

epidural analgesia ; pelvic

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