Pain, Acute, Polytrauma, Rib Fractures
Conditions
Keywords
Analgesia, Local anesthetics, Myofascial block, Ultrasound guidance
Brief summary
The analgesic effect of continuous mid-point to pleura transverse process block compared to the analgesic effect of continuous thoracic intervertebral foramen block, in patients with multiple rib fractures.
Detailed description
The analgesic effect of continuous mid-point to pleura transverse process block will be compared to the analgesic effect of continuous thoracic intervertebral foramen block, in patients with multiple rib fractures, by using the numeric rating scale (NRS) for pain.
Interventions
Under ultrasound guidance the continuous thoracic intervertebral foramen block, will be provided to achieve analgesia in polytraumatic patients with rib fractures. A set for continuous peripheral nerve block will be used. The infusion rate of analgesic solution (levobupivacaine 0.25% combined with dexamethasone 16 mg) will be titrated to patient perceived pain. The block will be performed close, by considering the level of rib fractures.
PROCEDUREMid-point to pleura transverse process block
Under ultrasound guidance the continuous mid-point to pleura transverse process block, will be provided to achieve analgesia in polytraumatic patients with rib fractures. A set for continuous peripheral nerve block will be used. The infusion rate of analgesic solution (levobupivacaine 0.25% combined with dexamethasone 16 mg) will be titrated to patient perceived pain. The block will be performed close, by considering the level of rib fractures.
Sponsors
San Salvatore Hospital of L'Aquila
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* ribs fracture after polytrauma
Exclusion criteria
* pregnancy * allergy to anesthetics * head trauma * history of neurological impairment (primary or secondary) * history of cancer * history of chronic obstructive pulmonary disease * infections of skin close to the block site * systemic infections
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain intensity | First 72 hours from the block | The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. no pain) to '10' representing the other pain extreme (e.g. pain as bad as you can imagine or worst pain imaginable |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Arterial blood gas analysis | First 72 hours from the block | Fraction of inspired oxygen to partial pressure of oxygen ratio |
| Airflow rate | First 72 hours from the block | Patient airflow rate measured in mL/second, by using an incentive spirometer with three balls |
| Blood pressure | First 72 hours from the block | Invasive blood pressure (systolic and diastolic pressure in mmHg) |
| Diaphragmatic motion | First 72 hours from the block | The percentage of diaphragmatic thickening measured as thickness at end-inspiration-thickness at end-expiration divided by thickness at end-expiration |
| Request of analgesic drugs | First 72 hours from the block | Consumption of analgesic drugs (equivalent mg of morphine) |
| Anesthetic spread | First 72 hours from the block | Thoracic paravertebral space spread (yes or no), evaluated with ultrasonography |
| Complication | First 72 hours from the block | Number of pneumothorax, hemothorax, hematoma, pain, infection, and neurological impairment by the block |
| Sensory block | First 72 hours from the block | Response to the stimulus (yes or no), by using a piece of cotton, and ice in a finger of surgical glove on the patient's skin. |
Countries
Italy
Outcome results
None listed