- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03413059
Thoracic Epidural Analgesia in Flail Chest
January 21, 2018 updated by: Mostafa hassanien hassanien bakr, Assiut University
Thoracic Epidural Morphine Versus Triamcinolone Acetonide Analgesia in Flail Chest
The applicability of different thoracic epidural analgesia for patients with flail chest
Study Overview
Status
Unknown
Conditions
Intervention / Treatment
Detailed Description
Pain due to traumatic rib fractures may be associated with increased morbidity and mortality.
Fracture ribs cause severe pain that adversely affects patients' ability to cough and breathe deeply, that may lead to decreased ventilator efforts, atelectasis, pneumonia and finally respiratory failure.
That further results in longer intensive care unit (ICU) and hospital length of stay and higher mortality.
Effective pain relief, chest physiotherapy and respiratory care are the points of management.
Effective analgesia enables the patient to breathe deeply, cough out the secretions and comply with chest physiotherapy.
Multiple pain relief treatment options are available, such as oral analgesics, intravenous opioids, patient-controlled opioid analgesia, interpleural blocks, intercostals blocks, para vertebral blocks, and epidural analgesia Recent studies reported that epidural analgesia reduces morbidity after major thoracic, abdominal and vascular surgeries, but in patients with rib fractures, Successful treatment for rib fracture pain usually requires both pharmacologic and interventional approaches .Single modality treatment, which may incite respiratory depression, is suboptimal in these patients, many of whom already manifest a compromised respiratory system.
Interventional procedures, while opioid sparing, carry their own inherent risks.
Intercostals nerve blocks may not be feasible in the setting of multiple rib fractures, because of patient discomfort and the risk of local aesthetic toxicity.
Use of an epidural catheter with continuous infusion of local anaesthetics and opioids may pose challenges in a community hospital setting, as 24 hours in-house coverage is often unavailable.
While single-shot thoracic epidural steroid injections have been used for herniated intervertebral discs, herpes zoster pain, and post herpetic neuralgia (PHN), their use in patients with rib fracture pain has not been previously reported in the literature.
An epidural steroid injection delivers steroids directly into the epidural space in the spine.
Sometimes additional fluid (local aesthetic and/or a normal saline solution) is used to help 'flush out' inflammatory mediators from around the area that may be a source of pain ..Typically, a solution containing cortisone (steroid) with local aesthetic (lidocaine or bupivacaine), and/or saline is used.A steroid, or cortisone, is usually injected as an anti-inflammatory agent.
Inflammation is a common component of many low back conditions and reducing inflammation helps reduce pain.
Triamcinolone acetonide, Dexamethasone, and Methyl prednisolone acetate are commonly used steroids.
Study Type
Interventional
Enrollment (Anticipated)
40
Phase
- Phase 2
- Phase 3
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: mostafa H hassanein bakr, MBBCH
- Phone Number: +201004727908
- Email: mostafabakr566@gmail.com
Study Contact Backup
- Name: Emad Z Saed, MD
- Phone Number: +201007046058
- Email: Emadzarief@yahoo.com
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 60 years (Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Older than 18 years.
- American Society of Anesthesiologists physical status 1 or 2.
- mentally competent and able to give consent for enrollment in the study
Exclusion Criteria:
- Patient refusal.
- Psychiatric disorder
- Patient younger than 18 years old
- Allergy to local anesthetics, systemic opioids (fentanyl, morphine)
- Impaired kidney functions and patient with coagulopathy will be also excluded.
- Chronic pain syndromes and patients with chronic opioid use defined as use of regular daily doses of systemic narcotics for the past 6 months prior to the surgery.
- BMI of 40 or more
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: morphine sulfate group
patients in this arm will receive : morphine dose 0.1mg /kg with 9 ml of 0.25 % bupivacaine with through epidural catheter on admission Then continuous epidural infusion of bupivacaine (0.1 mg.kg-1.h)
1st 72 hours
|
Thoracic Epidural morphine
Other Names:
|
Active Comparator: triamcinolone acetonide group
patients in this arm will receive will receive a mixture of 9 ml of 0.125 % bupivacaine with 80mg of triamcinolone ( 10 ml total volume) through epidural catheter on admission
|
thoracic epidural triamcinolone acetonide
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
visual analogue score
Time Frame: 7 days
|
mean visual analogue score (scale of 0 to 100) indicating the severity of pain
|
7 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
ICU stay
Time Frame: 7 days
|
from ICU admission to ICU discharge
|
7 days
|
chest infection
Time Frame: 7 days
|
incidence of developing chest infection
|
7 days
|
hospital stay
Time Frame: 7 days
|
length of hospital stay
|
7 days
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Emad Z Saed, Lecturer. ansethsia department. Faculty of medicine .assuit unveristy.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Anticipated)
February 1, 2018
Primary Completion (Anticipated)
July 1, 2018
Study Completion (Anticipated)
July 1, 2018
Study Registration Dates
First Submitted
April 26, 2017
First Submitted That Met QC Criteria
January 21, 2018
First Posted (Actual)
January 29, 2018
Study Record Updates
Last Update Posted (Actual)
January 29, 2018
Last Update Submitted That Met QC Criteria
January 21, 2018
Last Verified
June 1, 2017
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Wounds and Injuries
- Thoracic Injuries
- Flail Chest
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Enzyme Inhibitors
- Analgesics
- Sensory System Agents
- Anti-Inflammatory Agents
- Immunosuppressive Agents
- Immunologic Factors
- Glucocorticoids
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Analgesics, Opioid
- Narcotics
- Triamcinolone
- Triamcinolone Acetonide
- Triamcinolone hexacetonide
- Triamcinolone diacetate
- Morphine
Other Study ID Numbers
- IRB1000
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Flail Chest
-
University of British ColumbiaCompleted
-
Legacy Biomechanics LaboratorySynthes Inc.CompletedFlail ChestUnited States
-
Sahlgrenska University Hospital, SwedenCompletedRib; Fracture, Multiple, With Flail ChestSweden
-
Virginia Commonwealth UniversitySynthes Inc.Terminated
-
The AlfredCompletedVentilation | Flail ChestAustralia
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Poitiers University HospitalUnknownPolytraumatises With Rib FracturesFrance
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Darwin AngRecruitingFlail Chest | Rib FractureUnited States
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Sunnybrook Health Sciences CentreRecruitingPain | Trauma | Pain, Acute | Trauma Injury | Pain, Chronic | Rib Fractures | Rib Fracture Multiple | Rib; Fracture, With Flail ChestCanada
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Sahlgren´s University HospitalKarolinska University Hospital; Sahlgrenska University Hospital, SwedenCompletedTrauma | Surgery | Flail Chest | Rib FracturesSweden
Clinical Trials on Morphine Sulfate
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Roxane LaboratoriesCompleted
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University of Alabama at BirminghamActive, not recruiting
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Assiut UniversityCompleted
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Stanford UniversityTerminated
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MedtronicNeuroTerminated
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Indiana UniversityCompletedNeonatal Abstinence Syndrome | Neonatal Opioid Withdrawal Syndrome | Neonatal Opioid WithdrawalUnited States
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QRxPharma Inc.Completed
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Xuanhan County People's HospitalCompletedAnalgesia | Gynecological; Surgery (Previous), Affecting Fetus or Newborn, Due to Obstructed LaborChina
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Actavis Inc.Completed