Continous epidural and intravenous opioid analgesia on haemodynamic stability after several pelvic fracture

Backgraund and purpose: Continous 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 application with need for parenteral use of high dose of opioids. The aim was to compere the influence of early continous epidural and kontinous intarvenous opioid analgesia after first 24 hours on haemodinamic changes in patients with pelvic trauma. Materials (Patients) and methodes: Fifty trauma patients with multiple pelvic fractures were divided in two equal groups and included in prospective, randomized study. In bought groups analgesia was started with sufentanil 10 ug/h during the first 24h. In Group EP continous epidural analgesia (levibupivacain O.125%, 5-7 ml/h) was started after 24h. In Group O continous infusion of opioid (sufentanil 5-10 ucg/h) was followed. The titration dose of analgetics in the bought groups following the VAS score under 3. PICCO monitoring was establisch. MAP, CI, HR, SVRI, ITBVI and EVLWI was measured. Results: Under first 24 hours in bought groups were the high need for fluid replacement (EVLWI<10)(P=0.9864). SVRI was lower in O Group (800-1000) than EP Group (1100-1200)(P=0.0243) and recovered with 500-750 ml of cristaloids. ITBVI was stastistical more stable in Group EP (850) to compare Group O (950-1000)(P=0.0002). Conclusion: Early continous epidural analgesia with 0.125% levibupivacain is safe as continous opioid analgesia in patients with multiple pelvic fractures but without opioids complications and better haemodinamic stability.