None listed
Conditions
Brief summary
This study aims to determine if continuous thoracic erector spinae block is as effective as continuous thoracic paravertebral block in providing analgesia to patients with unilateral, multiple rib fractures. If similar analgesia is achieved with the continuous thoracic erector spinae block, it will become a viable, less invasive and simpler alternative to the continuous thoracic paravertebral block which may result in more patients receiving timely analgesia. Participants will be randomised to receive either the erector spinae or paravertebral intervention. The primary outcome is pain scores, at rest and with coughing, provided by patients at 24hrs and 72hrs after the intervention.
Interventions
Comparison of two interventions in patients with unilateral multiple rib fractures.
Arm 1 - Provision of continuous thoracic paravertebral block.
Arm 2 - Provision of continuous thoracic erector spinae block.
Multiple rib fractures are a common injury found in the trauma patient. The thoracic paravertebral has become the gold standard for analgesia in patients with unilateral multiple rib fractures. The erector spinae block is a novel technique that has emerged as an alternative intervention an
Comparison of two interventions in patients with unilateral multiple rib fractures. Arm 1 - Provision of continuous thoracic paravertebral block. Arm 2 - Provision of continuous thoracic erector spinae block. Multiple rib fractures are a common injury found in the trauma patient. The thoracic paravertebral has become the gold standard for analgesia in patients with unilateral multiple rib fractures. The erector spinae block is a novel technique that has emerged as an alternative intervention and has gained popularity due to its relative ease and lower risk profile. Patients will be provided with a Patient Informed Consent Form to read and this will be discussed with the patient by a member of the research team. Patients can also withdraw consent at any time and will be provided with a Participant Withdrawal Form. An 18G epidural catheter kit will be utilised for performing these nerve blocks. For both interventions, once the space is accessed, an initial bolus of 20ml 0.5% Ropivacaine will be administered before a catheter is placed into the space and secured to the patients back. The continuous thoracic paravertebral block will then continue with a programmed intermittent bolus of 10ml/hr of 0.2% Ropivacaine. The continuous erector spinae block will continue with a programmed intermittent bolus of 20ml of 0.2% Ropivacaine every 2hrs. Patients will be provided with a Fentanyl PCA post procedure. Both interventions will be performed by Specialist Anaesthetists trained in the provision of regional anaesthesia. The nerve blocks will be performed in the theatre complex under ultrasound-guidance using sterile conditions as is our practice. Standard ANZCA monitoring will be attached and patients will be returned to the ward after a period of observation to ensure safety. Patients will be seen by the Acute Pain Service and their pain scores will be ascertained at 24hrs at rest and with coughing. The catheters will be left in place until the patient is deemed suitable for a transition to oral medications.
Sponsors
Dr Lucas Edwards
Study design
Allocation
Randomised controlled trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients with unilateral multiple rib fractures who have been referred to the Acute Pain Management service and are deemed appropriate for a regional anaesthetic technique.
Exclusion criteria
Inability to provide informed consent or understand english. Contraindications for regional anaesthesia including anticoagulation or local anaesthetic allergy. Local infection or trauma at the site of injection. Existing chronic pain disorders. Severe renal or hepatic disease. Significant spinal injury. The need for more than one regional catheter. Significant concomitant painful injuries.
Outcome results
None listed