Comparison of Epidural and Paracostal Catheter Placement for Pain Control After Rib Fractures

Exclusion criteria

• ✕. Localized rash or skin infection over the likely site of insertion (We never want to translocate infectious material from the skin to the epidural space or even into the soft tissue where paracostal catheters lay, although for these there is more flexibility in adjusting placement)
• ✕. Spinal/vertebral instability/fracture including any significant vertebral body injury and 3 or more spinous process fractures near the level of desired epidural placement (transverse process fractures are not considered a contraindication)
• ✕. History of extensive back surgery at the level of desired epidural placement
• ✕. Severe aortic stenosis, mitral stenosis, or pulmonary hypertension
• ✕. Inability to correct coagulopathy (to International Normalized Ratio\>1.5)
• ✕. Persistent hemodynamic instability (hypotension with Systolic Blood Pressure\<90 that does not respond to initial fluid boluses and requires ongoing pressors beyond the 72 hour window for enrollment)
• ✕. Inability to cooperate and participate in placement (if intubated and sedated, for example) or to lie in the correct position for placement (lateral decubitus for paracostal pain catheters, either sitting up or lateral decubitus for epidural placement)
• ✕. Concern for elevated intracranial pressure (we imagine these patients will also be intubated)