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Comparison of analgesic interventions for traumatic rib fractures: a systematic review and meta-analysis
- Source :
- European Journal of Trauma and Emergency Surgery
- Publication Year :
- 2018
- Publisher :
- Springer Science and Business Media LLC, 2018.
-
Abstract
- Purpose Many studies report on outcomes of analgesic therapy for (suspected) traumatic rib fractures. However, the literature is inconclusive and diverse regarding the management of pain and its effect on pain relief and associated complications. This systematic review and meta-analysis summarizes and compares reduction of pain for the different treatment modalities and as secondary outcome mortality during hospitalization, length of mechanical ventilation, length of hospital stay, length of intensive care unit stay (ICU) and complications such as respiratory, cardiovascular, and/or analgesia-related complications, for four different types of analgesic therapy: epidural analgesia, intravenous analgesia, paravertebral blocks and intercostal blocks. Methods PubMed, EMBASE and CENTRAL databases were searched to identify comparative studies investigating epidural, intravenous, paravertebral and intercostal interventions for traumatic rib fractures, without restriction for study type. The search strategy included keywords and MeSH or Emtree terms relating blunt chest trauma (including rib fractures), analgesic interventions, pain management and complications. Results A total of 19 papers met our inclusion criteria and were finally included in this systematic review. Significant differences were found in favor of epidural analgesia for the reduction of pain. No significant differences were observed between epidural analgesia, intravenous analgesia, paravertebral blocks and intercostal blocks, for the secondary outcomes. Conclusions Results of this study show that epidural analgesia provides better pain relief than the other modalities. No differences were observed for secondary endpoints like length of ICU stay, length of mechanical ventilation or pulmonary complications. However, the quality of the available evidence is low, and therefore, preclude strong recommendations.
- Subjects :
- Adult
medicine.medical_specialty
Adolescent
Critical Care
Rib Fractures
Sports medicine
medicine.medical_treatment
Analgesic
Psychological intervention
Critical Care and Intensive Care Medicine
law.invention
Young Adult
03 medical and health sciences
0302 clinical medicine
Blunt
Musculoskeletal Pain
law
Humans
Pain Management
Medicine
Anesthesia
Orthopedics and Sports Medicine
Mortality
Aged
Pain Measurement
Mechanical ventilation
Analgesics
030222 orthopedics
Modalities
business.industry
Nerve Block
030208 emergency & critical care medicine
Length of Stay
Middle Aged
Intensive care unit
Analgesia, Epidural
Hospitalization
Meta-analysis
Emergency Medicine
Administration, Intravenous
Original Article
Surgery
Analgesia
Epidemiologic Methods
business
Subjects
Details
- ISSN :
- 18639941 and 18639933
- Volume :
- 45
- Database :
- OpenAIRE
- Journal :
- European Journal of Trauma and Emergency Surgery
- Accession number :
- edsair.doi.dedup.....1c4451f703d2572146ea5a6f7aa86f48