الفهرس 
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Abstract
Thoracic epidural analgesia provides analgesia of the chest for patients with surgical incisions, rib fractures, thoracic herpes zoster and rib lesions.
The aim of this work was to study the effect of thoracic epidural analgesia compared to systemic analgesia as regard the pain scoring system, arterial blood gases and duration of hospital and ICU stay.
We conducted a prospective, randomized study of thirty consecutive patients all complaining of multiple rib fractures who were admitted to the unit of thoracic surgery in Menoufia university hospitals between December 2015 and July 2016.
The patients were randomly divided into two equal groups of fifteen patients. Patients of the first group were subjected to epidural analgesia on arrival (10 ml 0.125-0.25% bupivacaine) and repeated after 4-6 hours (group A). Patients of the other group were given Ketorelactromethamine, which is a non-steroidal anti-inflammatory drug, 30 mg IV on arrival and repeated every 8 hours (group B).
Our study revealed the following:
•The pain score was significantly lower in epidural group than systemic analgesia group after treatment by 6 hours & 24 hours.
•PO2 was significantly higher in the epidural group than in systemic analgesia group after treatment by 6 hours & 24 hours.
•PCO2 was significantly lower in the epidural group than in systemic analgesia group after treatment by 6 hours, while there was no significant difference between the two groups as regard PCO2 level after treatment by 24 hours.
•Hospital stay was significantly lower in the epidural group than systemic analgesia group.
•ICU stay was significantly lower in the epidural group than systemic analgesia group. However, there was no significant difference between the two groups as regards the need for ICU admission.
•Duration of mechanical ventilation was significantly lower in the epidural group than systemic analgesia group. However, there was no significant difference between the two groups as regards the need for mechanical ventilation.
Study limitations:
•Fewer patients number admitted at this period of time.
•Short follow up time.
•Single centre results only.
•Not considering other intervention procedures.
•Using one functional score only (Visual Analogue Scale )