Moskowitz Eliza E, Garabedian Lucin, Hardin Kimberly, Perkins-Pride Emily, Asfaw Menilik, Preslaski Candice, Leasia Kiara N, Lawless Ryan, Burlew Clay Cothren, Pieracci Fredric
Denver Health Medical Center University of Colorado School of Medicine, United States.
Injury. 2018 Sep;49(9):1693-1698. doi: 10.1016/j.injury.2018.06.002. Epub 2018 Jun 9.
Achieving adequate pain control for rib fractures remains challenging; prescription of alternatives to narcotics is imperative to curtail the current opioid epidemic. Although gabapentin has shown promise following elective thoracic procedures, its efficacy in patients with rib fractures remains unstudied. We hypothesized that gabapentin, as compared to placebo, would both improve acute pain control and decrease narcotic use among critically ill patients with rib fractures.
Adult patients admitted to the trauma surgery service from November 2016 - November 2017 at an urban, Level I trauma center with one or more rib fractures were randomized to either gabapentin 300 mg thrice daily or placebo for one month following their injury. Daily numeric pain scores, opioid consumption, oxygen requirement, respiratory rate, and incentive spirometry recordings during the index admission, as well as and one-month quality of life survey data were abstracted.
Forty patients were randomized. The groups were well matched with respect to age, gender, prior narcotic use, tobacco use, and prior respiratory disease. Although the median RibScore did not differ between groups, the gabapentin group had a higher median number of ribs fractured as compared to the placebo group (7 vs. 5, respectively). Degree of pulmonary contusion and injury severity score were similar between groups. Use of loco-regional anesthetic modalities did not differ between groups. Daily numeric pain scores, opioid consumption, oxygen requirement, respiratory rate, and incentive spirometry recordings were similar between both groups. No benefit was observed when adding gabapentin to a multi-modal analgesic regimen for rib fractures. There were no instances of pneumonia, respiratory failure, or mortality in either group. Hospital and intensive care unit length of stay were similar between groups. Both overall and chest-specific quality of life was equivalent between groups at one month follow-up.
In this group of critically ill patients with rib fractures, gabapentin did not improve acute outcomes for up to one month of treatment.
实现肋骨骨折的充分疼痛控制仍然具有挑战性；必须开具非麻醉性药物的处方以遏制当前的阿片类药物流行。尽管加巴喷丁在择期胸科手术后已显示出前景，但其在肋骨骨折患者中的疗效仍未得到研究。我们假设，与安慰剂相比，加巴喷丁既能改善急性疼痛控制，又能减少重症肋骨骨折患者的麻醉药物使用。
2016年11月至2017年11月期间，在一家城市一级创伤中心因一根或多根肋骨骨折而入住创伤外科的成年患者，在受伤后被随机分为每日三次服用300毫克加巴喷丁组或安慰剂组，为期一个月。提取了指数住院期间的每日数字疼痛评分、阿片类药物消耗量、氧气需求量、呼吸频率和激励肺活量测定记录，以及一个月的生活质量调查数据。
40名患者被随机分组。两组在年龄、性别、既往麻醉药物使用情况、吸烟情况和既往呼吸系统疾病方面匹配良好。尽管两组之间的肋骨骨折评分中位数没有差异，但与安慰剂组相比，加巴喷丁组的肋骨骨折中位数更高（分别为7根和5根）。两组之间的肺挫伤程度和损伤严重程度评分相似。两组之间局部区域麻醉方式的使用没有差异。两组之间的每日数字疼痛评分、阿片类药物消耗量、氧气需求量、呼吸频率和激励肺活量测定记录相似。在肋骨骨折的多模式镇痛方案中添加加巴喷丁未观察到益处。两组均未发生肺炎、呼吸衰竭或死亡病例。两组之间的住院时间和重症监护病房住院时间相似。在一个月随访时，两组的总体和胸部特定生活质量相当。
在这组重症肋骨骨折患者中，长达一个月的治疗期间加巴喷丁并未改善急性预后。
