None listed
Conditions
Brief summary
Broken ribs are common and hurt. The pain from broken ribs can restrict breathing and may cause serious problems (for example lung infections) for some people. Two common techniques used for managing pain are the Paravertebral Block, and the Erector Spinae block. Both techniques can be effective, but it is not clear which technique is better or safer. This pragmatic study is looking to see if these techniques are the same or not, in terms of both benefits (e.g. relieving pain, improved lung function), and potential harms (e.g. collapsed lung, need for intensive care).
Interventions
After consent, this pragmatic trial will randomise equal cohorts of patients with unilateral, image proven, blunt force (traumatic) rib fractures to receive one of two forms of regional anaesthesia.
The two arms are:
- Paravertebral block, and,
- Erector spinae plane block.
Both of these blocks involve the injection of local anaesthetics around the nerves of the back. The local anaesthetic in a paravertebral block is injected into the paravertebral space, and the local anaesthetic for the ere
After consent, this pragmatic trial will randomise equal cohorts of patients with unilateral, image proven, blunt force (traumatic) rib fractures to receive one of two forms of regional anaesthesia. The two arms are: - Paravertebral block, and, - Erector spinae plane block. Both of these blocks involve the injection of local anaesthetics around the nerves of the back. The local anaesthetic in a paravertebral block is injected into the paravertebral space, and the local anaesthetic for the erector spinae plane block is injected between the muscles of the participants back. The block will be preformed by either and anaesthetic consultant or anaesthetic registrar at the John Hunter Hospital, NSW, Australia. ANZCA required monitoring and sterility will be performed for all blocks. Both arms will receive 0.3ml/kg 0.375% ropivacaine (maximum of 20mls), followed by 20mls of 0.2% ropivacaine every four hours via intermittent programmed bolus.
Sponsors
University of Newcastle
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
- Age > 18 years - Admitted - Minimal other distracting injuries - Unilateral, traumatic rib fractures – diagnosed radiologically via CXR or CT - Pain requiring opioid analgesia - Physical and cogitative ability to consent and attempt spirometry, i.e. able to obey simple commands - Injury must be within 48hours from time to block
Exclusion criteria
- Pathological rib fractures (resulting from a non-traumatic – e.g. neoplastic – process) - Condition preventing positioning for ESB or PVB e.g. unstable spinal fracture - Distracting injuries or significantly impaired cognition e.g. multi-trauma, significant head injury o We are defining a distracting painful injury as ‘any injury producing acute functional impairment, or, any injury as if it is thought to have the potential to impair the patients ability to appreciate other injuries’ as used in NEXUS study - Coagulopathy or anticoagulated patients, in line with NYSORA guidelines - Infection over ideal approach for block - Any other contraindication for PVB or ESP - Presence of a sternal fracture - Rib fractures greater than 6 levels apart (e.g. 3 and 8 ok, 3 and 9 not ok). - Renal failure – eGFR < /= 30
Outcome results
None listed