Comparison of the Effect of Intravenous and Epidural Administration of Fentanyl on Pain Severity and Hemodynamic Status in Patients with Abdominal and Thoracic Trauma

Background : The pain of the chest and abdominal injuries in patients who undergoing mechanical ventilation is controlled by regional or systemic administration of drugs. We designed this study for comparison of effect of intravenous and epidural injection of fentanyl on pain reduction and hemodynamic status in patients with abdominal and thoracic injuries.
Materials and Methods : In this prospective clinical trial study, we randomly allocate 60 patients aged 16 to 80 years who were undergoing mechanical ventilation due to thoracic or abdominal injuries, to two groups. In B group during first 24 hour of admission pain management was done by epidural infusion of fentanyl and in the next 24 hours, this method was changed to intravenous infusion of fentanyl. In A group, initially method was intravenous and after 24 hours, we changed it to epidural method. We assessed pain score and hemodynamic status at the specific times.
Results : In both groups after first 2 hours, pain sore was significantly lower in intravenous method but after 6 hours, pain score was significantly lower in epidural method. Hemodynamic status in epidural method was significantly more stable than IV method.
Conclusion : This study showed that for patients who were undergoing mechanical ventilation due to chest or abdominal injuries, intravenous infusion of fentanyl provides more pain relief during first two hours but after six hours epidural method is better than intravenous infusion.