Thoracic epidural analgesia in the treatment of rib fractures.

Rib fractures and flail chest could be fatal if gas exchange is impaired. Efficient pain relief with continuous thoracic epidural analgesia allows a good physiotherapy management without central sedation and impairment of cough reflex, this prevents pulmonary atelectasis and infection. Eighteen patients/19 were treated with success in spite of flail chest, chronic obstructive pulmonary disease and minor pulmonary contusion. Intermittent positive pressure ventilation must be reserved to severe pulmonary contusion and other crushing injuries of the chest as bronchial or great vessels ruptures.