None listed
Conditions
Brief summary
Rib fractures are painful and affect the ability to cough and deep breathe, resulting in a high risk of complications, such as pneumonias, lung collapse and the need for mechanical ventilation (life support). Numbing the nerves to the fractured ribs by injecting local anaesthetic (LA) improves breathing and reduces the risk of complications. Two techniques are commonly used at the RBWH; erector spinae plane blocks (ESPB) and paravertebral blocks (PVB). The techniques are similar, however the LA is injected near nerves at two different locations. The PVB is immediately adjacent to the vertebrae, whereas the ESPB is slightly further away from the midline. Both techniques use ultrasound to ensure the LA is directed to the intended place. Adult patients with > 3 rib fractures will be consented, then randomised to receive either a ESPB or a PVB. The anaesthetist will know which procedure the patient has been randomised to, however once the ultrasound is gone, the locations are so close that patient and staff can be blinded. It is expected that both groups will significantly improve in terms of pain score, opioids needed, and breathing ability (spirometry) however it is unclear which technique will provide better results.
Interventions
This study will compare the safety and efficacy of two interventions in patients with rib fractures. Both interventions are regional anaesthetic techniques where a continuous infusion of local anaesthetic is delivered to nerves travelling to the ribs, however the catheter will be inserted into different locations.
Arm 1: Erector spinae plane
Arm 2: Paravertebral space
Both will have the same prescription for ongoing local anaesthetic delivery - 10ml/hr 0.2% ropivacaine. All interventions will
This study will compare the safety and efficacy of two interventions in patients with rib fractures. Both interventions are regional anaesthetic techniques where a continuous infusion of local anaesthetic is delivered to nerves travelling to the ribs, however the catheter will be inserted into different locations. Arm 1: Erector spinae plane Arm 2: Paravertebral space Both will have the same prescription for ongoing local anaesthetic delivery - 10ml/hr 0.2% ropivacaine. All interventions will be performed by consultant anaesthetists, or advanced trainees in anaesthesia who are competent at these types of blocks. In order to enhance the fidelity of the interventions, the consultant anaesthetists performing the regional nerve blocks are a small group of select consultants who are highly skilled in this area. It is voluntary to allow their patients to be a part of this trial and all consultants taking part believe in the value of high quality research in this area. Wherever possible, the interventions will be supervised by a research team member, and all ongoing prescriptions will be reviewed to ensure they reflect the study protocol prescription in its entirety. Where it is not possible to supervise the intervention (e.g. weekends) it is common practise to record the procedure on the ultrasound machine, and this can be checked by a research team member.
Sponsors
Royal Brisbane and Women's Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
• Patients aged 18 to 85 • Isolated unilateral rib fractures with no significant other distracting injuries • Greater than 3 rib fractures • Patients who have been assessed by the Acute Pain Management Service and recommended for a regional analgesia catheter treatment (ESP or PVB Catheter) • Patients able to communicate pain scores, request appropriate additional analgesia
Exclusion criteria
• Patients who are unable to communicate effectively due to poor English, dementia or brain injury • Patients admitted to the intensive care unit for invasive ventilatory support • Patients with significant other injuries • Patients with pre-existing opiate dependence of greater than 30mg morphine equivalents per day • Significant renal or hepatic dysfunction • Known or suspected allergy to amide local anaesthetic agents • Uncontrolled infection • Significant coagulopathy
Outcome results
None listed