Chest Tube Insertion, Pain Management, Thoracostomy Pain Management
Conditions
Keywords
tube thoracostomy, pain control, pain managment
Brief summary
In the emergency department, tube thoracostomy is a common critical procedure to manage symptomatic pleural issues such as pneumothorax and pleural effusion.\[1\] This technique employed to remove air or fluid from the pleural cavity, restore negative intrapleural pressure and let the lungs expand again to help normal cardiopulmonary function to be restored again. \[2\] However, the procedure is often associated with significant pain, with approximately 50% of patients reporting pain levels between 9-10 out of 10 during the intervention, and for pain management emergency physicians have traditionally combined local anesthetics with opioids or anxiolytics. Yet, these methods have notable drawbacks: opioids carry risks of addiction and adverse side effects (e.g., nausea/vomiting, respiratory depression, delirium), while procedural sedation is time-intensive, requires monitoring, and carries risks of complications such as apnea and hypotension.\[3\] Local anesthetic infiltration for pain management can also fail to effectively and evenly target the intercostal nerves responsible for chest wall sensation.\[4\] Ultrasound-guided fascial plane blocks (erector spinae plane and serratus plane blocks) have recently been proposed as targeted alternatives for reliable and extended pain control of tube thoracostomy as each block produces a unique distribution of anesthesia. \[5\] Despite establishing of these techniques for pain control during thoracic surgeries, its application in emergency settings for tube thoracostomy is underexplored enough yet \[6\], a gap explicitly identified in the recent literature.\[4\] Therefore, in this study we evaluate the impact of ESP and SAP block for pain management and overall quality of recovery which practically performed by emergency physicians.
Interventions
PROCEDUREserratus anterior plane blocks
Ultrasound-guided fascial plane block,serratus plane blocks for reliable and extended pain control of tube thoracostomy using 20-30 mL of bupivacaine 0.25%
PROCEDUREErector Spinae Plane Block
Ultrasound-guided fascial plane block,Erector spinae plane block for reliable and extended pain control of tube thoracostomy using 20-30 mL of bupivacaine 0.25%.
Sponsors
Assiut University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Adults aged ≥18 to =\<60 years presenting to the ED requiring tube thoracostomy. * hemodynamically stable (systolic blood pressure ≥90 mmHg). * Able to provide informed consent.
Exclusion criteria
* Tension pneumothorax or hemodynamic instability requiring immediate tube insertion without time for block performance. * Known allergy or hypersensitivity to local anesthetics. * Infection or cellulitis overlying the intended needle insertion site. * Chronic opioid use/dependence, or substance use disorder that would confound pain and opioid-consumption outcomes. * Psychiatric illness, cognitive impairment, intoxication, or severe traumatic brain injury (GCS \< 13) precluding reliable pain-score reporting or informed consent. * Body mass index ≥ 30 kg/m² (sonoanatomic landmarks less reliable). * Patients with spinal injury. * Patinets with fracture rib.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Intraprocedural pain score (NRS 0-10) recorded immediately after tube insertion and pleural fixation. | 24 HR |
Secondary
| Measure | Time frame |
|---|---|
| Total rescue opioid/sedative dose. | 24 HR |
| Time required to perform the block (needle-in to needle-out). | first 24 HR |
| procedure-related complications (pneumothorax, hematoma, local anesthetic systemic toxicity, block failure). | first 24 HR |
Countries
Egypt
Contacts
CONTACTArwa Salah Arwa
Outcome results
None listed