• N Kariya, Y Oda, H Yukioka, and M Fujimori.
• Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School, Osaka.
• Masui. 1996 Feb 1; 45 (2): 223-6.

AbstractA 46-year-old man involved in a traffic accident was admitted to our university hospital for treatment of acute subdural hematoma of the brain, multiple rib fractures and hemothorax. On admission, he manifested disturbance of consciousness, and his left upper and lower extremities were paralyzed. Blood gas analysis revealed hypoxia, and he was nasotracheally intubated. He was mechanically ventilated with 10 cmH2O positive end-expiratory pressure for treatment of rib fractures following surgical removal of the subdural hematoma and insertion of a sensor into the epidural space for measurement of intracranial pressure. Despite continuous intravenous infusion of midazolam and buprenorphine, he was agitated and thrashed from side to side, probably due to severe chest pain caused by rib fractures. Agitation was effectively controlled by continuous thoracic epidural administration of morphine and bupivacaine. Intracranial pressure did not increase, and epidural analgesia was without sequelae. The patient's level of consciousness gradually improved, rib fractures were treated and he was extubated on the 25th hospital day. These findings indicate that epidural analgesia is useful for controlling pain-related agitation caused by head and chest injuries if increased intracranial pressure is not present.

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