Safety, complications and clinical outcome after ultrasound-guided paravertebral catheter insertion for rib fracture analgesia: a single-centre retrospective observational study
| Autor: | I. A. Walker, J. Womack, J. D. Pearson, B. A. Goodman, N. M. Stephens |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Rib Fractures medicine.medical_treatment Pain Thoracic Vertebrae 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology medicine Humans Pain Management 030212 general & internal medicine Hospital Mortality Anesthetics Local Reduction (orthopedic surgery) Ultrasonography Interventional Aged Pain Measurement Retrospective Studies Aged 80 and over Catheter insertion business.industry Ultrasound Retrospective cohort study Nerve Block Middle Aged Ultrasound guided Surgery Catheter Anesthesiology and Pain Medicine Standardized mortality ratio England Propensity score matching Female business |
| Zdroj: | Anaesthesia. 74(5) |
| ISSN: | 1365-2044 |
| Popis: | Rib fractures are associated with significant morbidity and mortality. Ultrasound-guided thoracic paravertebral catheter insertion has been described for the management of pain secondary to rib fractures. We conducted a retrospective observational study of all patients with rib fractures who had a paravertebral catheter inserted for analgesia provision over a 4-year period. Data from the Trauma Audit and Research Network were used to compare patients with rib fractures who were managed with paravertebral catheters to those managed with systemic analgesia. A total of 314 consecutive paravertebral catheters were inserted in 290 patients. Five (1.9%) catheters were removed due to ineffective analgesia. Other minor complications occurred in three cases (0.96%). The proportion of rib fracture patients managed with paravertebral catheters increased from 31/200 (15.5%) in the first year of study to 81/168 (48.2%) in the fourth; over this time-period the observed:predicted mortality ratio fell from 1.04 to 0.66. Proportional hazard regression with and without propensity score matching demonstrated a reduction in mortality associated with paravertebral catheter use, but this became statistically non-significant when time-dependent analysis was used. Paravertebral catheters are a safe and effective technique for rib fracture analgesia; however, our data were insufficient to demonstrate any improvement in mortality. |
| Databáze: | OpenAIRE |
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