- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03711812
Serratus Anterior Block and Catheter Use in Rib Fractures in the Emergency Department (SABRE)
SABRE: Serratus Anterior Block and Catheter Use in Rib Fractures in the Emergency Department
The main aim of this study is to determine whether Serratus Anterior Plane (SAP) blockade provides improved pain relief after rib fractures compared to epidural administration of local anaesthetic. The investigators aim to show that SAP catheters (SAPC) can be placed in more situations and are less operator-dependent then thoracic epidural anaesthesia (TEA). This reduces the waiting time required to achieve satisfactory analgesia in the patient. Optimal analgesia allows early respiratory physiotherapy and reduction in the complications of multiple rib fractures.
Pain from rib fractures is severe. The sensory nerves of the thoracic wall lie in the SAP and a single ultrasound-guided injection of local anaesthetic spreads widely and provides useful post-injury analgesia for several hours. If a catheter is left in the SAP, the nerve blockade can be maintained for several days.
Rib Fracture pain is traditionally treated with oral/ intravenous analgesics or TEA. Opiate analgesia via patient controlled analgesia (PCA) can work very well but it is associated with excessive sedation, constipation, nausea and vomiting. Continuous TEA is generally regarded as the gold standard but it demands monitoring by adequately trained ward staff and is commonly associated with high failure rates and increased risk of complications. SAPC has also been used when TEA and PCA were not desirable.
The primary outcome will be the amount of morphine analgesia required by the patient. Secondary outcomes will be pain scores (at rest and on movement), the side effects of morphine, complications of TEA/ SAPC, respiratory function changes and a quality of recovery assessment.
The control group will have an epidural block and catheter placed. The treatment group will have SAP blocks and catheters placed under ultrasound guidance. Both blocks will be tested to ensure good pain relief. To avoid potential confounding effects, oral painkillers will adhere strictly to the study protocol.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
London, United Kingdom
- Imperial College Healthcare NHS Trust
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients aged over 18 years suffering 2 or more rib fractures
Exclusion Criteria:
- Significant renal dysfunction (baseline creatinine >150μmol/l - morphine contra- indicated)
- Pregnancy
- Patients with chronic pain on regular analgesic medication
- Patients with significant coagulation abnormality (unsafe to site blocks)
- Participation in another interventional study that will interact with this trial.
- Patients unable to give informed consent
- Hypersensitivity to local anaesthetic (or any other study drug).
- Contraindication to NSAID (peptic ulceration or sensitive asthma)
- Weight <50kg
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Serratus Anterior Plane Catheter
|
Insertion of a Serratus Anterior Plane Catheter to establish a continuous analgesic block with a local anaesthetic infusion
|
Placebo Comparator: Thoracic Epidural
|
Insertion of a Thoracic Epidural Catheter to establish a continuous analgesic block with a local anaesthetic infusion
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
intravenous morphine use via a patient controlled pump
Time Frame: 72 hours
|
This will be measured as the total amount (in milligrams) of intravenous morphine used via a patient controlled pump in 72 hours.
|
72 hours
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
static and dynamic pain scores measurements
Time Frame: 72 hours
|
This will be measured using a visual analogue scale from 0(no pain) to 10(unbearable pain).
The measurement will be done whilst the patient is at rest and again on movement.
|
72 hours
|
side effects/ complications of interventions
Time Frame: 72 hours
|
The side effects and complications of either a thoracic epidural or serratus anterior plane block will be recorded.
This includes failure to establish the block and/or catheter, decreased blood pressure, neurological sequelae, nausea and vomiting and itching.
|
72 hours
|
spirometry
Time Frame: 72 hours
|
Spirometry will be undertaken at the bedside and the tidal volumes will be recorded 3 times and the average taken of the 3 measurements.
|
72 hours
|
quality of recovery assessment
Time Frame: 72 hours
|
The quality of recovery (QoR) will be assessed using the QoR40.
The QoR-40 is a 40-item questionnaire that provides a global score and subscores across five dimensions: patient support, comfort, emotions, physical independence, and pain.
|
72 hours
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 232220
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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.
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