Analgesia, Diaphragmatic Excursion, Edge of Laminar Block, Erector Spinae Block, Multiple Rib Fractures
Conditions
Brief summary
This prospective randomized clinical trial aims to compare the effect of continuous erector spinae plane block versus continuous edge of laminar block on the quality of analgesia and diaphragmatic excursion in patients with unilateral traumatic multiple rib fractures.
Detailed description
Rib fractures occur in up to 12% of all trauma patients, most commonly due to blunt thoracic trauma, and pose a significant health care burden with their associated morbidity and mortality. The erector spinae plane block (ESB) is a myofascial plane technique in which a needle is inserted under ultrasound guidance deep to the erector spinae muscle group, allowing an infusion of local anesthetic to diffuse to both the dorsal and ventral rami of the spinal nerves, thereby supplying the rib cage. This technique can be used as a single-shot method or to facilitate the placement of a catheter, allowing for continuous infusion and/or intermittent bolus to provide long-lasting analgesia. The edge of laminar block (ELB) is a novel technique in which local anesthetics are injected at the lateral edge of the lamina. It has been proven to provide sensory analgesia during rib fractures.
Interventions
OTHERErector spinae block
Patients will receive continuous ipsilateral erector spinae plane block.
OTHEREdge of lamina block
Patients will receive continuous ipsilateral edge of laminar block.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Aged between 21 and 65 years. * Both sexes. * With unilateral traumatic multiple fracture ribs (≥ 3), admitted to the surgical intensive care unit within the first day of trauma.
Exclusion criteria
* Patients' rejection. * Body mass index ≥ 35 (kg/m2). * Bleeding and Coagulation disorders. * Known hypersensitivity to the study drugs. * Vertebral deformity. * Respiratory, cardiac, renal or hepatic dysfunction. * Patients with major trauma involving extra-thoracic structures (e.g., head, spine, pelvis, and abdominal visceral injuries). * Mental or cognitive dysfunction, * History of chronic analgesic or drug abuse. * Local infection at the site of the block.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total morphine consumption | 4 days postoperatively | If the Numeric Rating Scale (NRS) is 4 or more IV morphine 3mg will be given. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Diaphragmatic excursion | 4 days postoperatively | Diaphragmatic excursion will be assessed before the block, at 60 minutes after the block, and then every 8 hours for 4 days. |
| Incidence of adverse events | 4 days postoperatively | Incidence of adverse events such as hematoma, local anesthetic systemic toxicity, respiratory complications, pneumothorax, nausea, and vomiting. |
| Degree of pain | 4 days postoperatively | The degree of pain will be assessed using the Numeric Rating Scale (NRS) at rest and on coughing will be assessed before the block, at 60 minutes after the block, and then every 8 hours for 4 days. |
| Forced expiratory volume 1 | 4 days postoperatively | Forced expiratory volume 1 (FEV1) will be assessed before the block, at 60 minutes after block, and then every 8 hours for 4 days. |
| Forced expiratory volume 1 (FEV1)/Forced vital capacity (FVC) | 4 days postoperatively | Forced expiratory volume 1 (FEV1)/Forced vital capacity (FVC) will be assessed before the block, at 60 minutes after block, and then every 8 hours for 4 days. |
| Forced vital capacity | 4 days postoperatively | Forced vital capacity (FVC) will be assessed before the block, at 60 minutes after block, and then every 8 hours for 4 days. |
Countries
Egypt
Contacts
Primary ContactHeba A Muhammed, Master
Outcome results
None listed