Management of blunt chest injury.

The development of regional techniques of analgesia has revolutionized the management of blunt thoracic trauma. The standard of care has evolved from intubation and mechanical ventilation for all patients to optimization of pain control combined with chest physiotherapy. Although many methods have been used, it appears that in appropriately selected patients, epidural analgesia is the preferred technique for pain control in severe thoracic trauma. Epidural catheters for continuous narcotic or local anesthetic administration are both the most reliable and the most effective, and once in place they can be managed by nursing outside of the intensive care setting. It still remains for improvement in outcome to be demonstrated when epidural analgesia is used, but it is clear that subjective patient comfort is increased and that pulmonary parameters can be improved. In appropriately selected patients, those without head injury or who have been adequately evaluated for intra-abdominal injury, epidural analgesia is currently the preferred method for pain control following severe thoracic trauma.