Original scientific paper

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

DUBRAVKA BARTOLEK ; Clinic Hospital Centre »Sister of Mercy«, University Hospital of Traumatology, Department of Anaesthesiology and Intensive Care Unit, Zagreb, Croatia
KATA ŠAKIĆ-ZDRAVČEVIĆ ; University Hospital »St. Spirit«, Department of Anaesthesiology and Intensive Care Unit, Zagreb, Croatia
DIJANA FINCI ; Clinic Hospital Centre »Sister of Mercy«, University Hospital of Traumatology, Department of Anaesthesiology and Intensive Care Unit, Zagreb, Croatia
RENATA LETICA-BRNADIĆ ; Clinic Hospital Centre »Sister of Mercy«, University Hospital of Traumatology, Department of Anaesthesiology and Intensive Care Unit, Zagreb, Croatia
INGRID PRKAČIN ; Clinic Hospital »Merkur«, Department of Internal Medicine, Zagreb, Croatia
ŠIME ŠAKIĆ ; Clinic Hospital Centre »Šalata« Orthopaedic Clinic, Zagreb, Croatia
ALEKSANDRA MUNJIZA ; Clinic Hospital Centre »Sister of Mercy«, University Hospital of Traumatology, Department of Surgery, Zagreb, Croatia
GORDANA CAVRIĆ ; Clinic Hospital »Merkur«, Department of Internal Medicine, Zagreb, Croatia
MIROSLAV ŽUPČIĆ ; Clinical Hospital Dubrava, Department of Anaesthesiology and Intensive Care Unit, Zagreb, Croatia

Abstract

Background and Purpose: Continuous epidural analgesia improves excellent pain control in trauma patients with multiple pelvic fractures. Rezidual haemodynamic 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 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 μg 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 μg 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 infusion. ITBVI was statistical more stable inGroup EP (950 ± 50; Group O (1100 ± 30)(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.

Keywords

epidural analgesia; pelvic fracture; trauma

Hrčak ID:

68924

URI

https://hrcak.srce.hr/68924

Publication date:

1.6.2011.

Visits: 1.522 *