Role of Nerve Block in Management of Multiple Rib Fractures

April 26, 2025 updated by: Mostafa Kotb, Assiut University

Management of Multiple Rib Fractures; Role of Nerve Block

  • Epidemiology & Impact Thoracic trauma is a common and serious injury worldwide-especially in developing countries-and carries high rates of morbidity and mortality. Complications arise primarily from hypoventilation, which leads to atelectasis, pneumonia, and respiratory failure.
  • Key to Reducing Complications: Pain Control Effective analgesia is the cornerstone of preventing respiratory complications. Inadequate pain relief causes patients to splint and hypoventilate, setting the stage for pulmonary collapse and infection.
  • Conservative Management
  • Analgesics: Systemic pharmacological pain relief remains the mainstay.
  • Supportive Measures: Rest, application of ice, and encouragement of deep breathing exercises.
  • Incentive Spirometry: Promoted in all patients to maintain lung expansion and ward off atelectasis.
  • Regional Anesthesia Techniques

To further improve comfort and respiratory mechanics, ultrasound-guided nerve blocks are employed according to fracture location:

  • Serratus Anterior Plane Block for anterolateral rib fractures
  • Thoracic Paravertebral Block for posterior rib fractures
  • Surgical Intervention Reserved for complex cases-such as flail chest or fractures with risk of organ injury-where stabilization or repair may be necessary.
  • Identified Gap Despite these options, thoracic surgeons currently lack a standardized, procedure-specific pain management protocol beyond systemic analgesics, highlighting a need for consensus guidelines that integrate pharmacological and regional techniques.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Thoracic trauma is a major traumatic injury throughout the world, and it has very high incidence in developing countries. Thoracic trauma is often associated with significant morbidity and mortality. Morbidity is due to atelectasis, pneumonia, and respiratory failure as a sequence of hypoventilation.

Most important factor in preventing complications in these patients is pain management. There are different lines of management of multiple rib fractures; conservative therapy is a common line of management which includes appropriate analgesic, rest, and ice.

The use of an incentive spirometer should be encouraged to prevent pulmonary atelectasis and splinting.

Nerve block can also be applied to aid in pain control, surgery may also be a line of management for complicated cases.

The type of nerve block differs according to the site of the fracture; Ultrasound-Guided Serratus Anterior Plane Block is often used for anterolateral rib fractures and Ultrasound-Guided Thoracic Paravertebral Block is used for posterior rib fractures.

The problem here is that ; There is no pain management protocol to be done by thoracic surgeons other than pharmacological analgesics.

This randomized prospective study will be performed in Assiut University Hospitals on two groups of trauma patients, each group is 37 patients; one will undergo nerve block by injection of Lidocaine (7mg/kg) with Epinephrine 1:100000 under ultrasonographical guidance and the other will receive pharmacological analgesics (Oral Paracetamol (500mg/6hr), IV Ketolac (15mg/6hr) and IV perfelgan (1gm/6hr)).

Then improvement in patients pain score, intercostal tube duration in days and total hospital stay in days, patient satisfaction using questionnaire will be assessed.

Study Type

Interventional

Enrollment (Estimated)

74

Phase

  • Phase 4

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

Study Contact Backup

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

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • All trauma adult patient (18-70 years) with multiple fracture ribs

Exclusion Criteria:

  • Patient with multiple fracture rib with anterior flail segment
  • Significant head trauma

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: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: nerve block
Procedure: Nerve block with Lidocain
Injection of Lidocaine (7mg/kg) with Epinephrine 1:100000 under Ultrasonographical guidance
Active Comparator: pharmacological analgesics
Drug: pharmacological analgesics
Oral Paracetamol (500mg/6hr), IV Ketolac (15mg/6hr) and IV perfelgan (1gm/6hr)

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Improvement in patients pain score (neumerical score)
Time Frame: day 0, day 1 and day 3
day 0, day 1 and day 3

Secondary Outcome Measures

Outcome Measure
Time Frame
improving intercostal tube duration in days
Time Frame: day 2, day 4 and day 6
day 2, day 4 and day 6
improving total hospital stay in days
Time Frame: day 2, day 4 and day 6
day 2, day 4 and day 6
improving patient satisfaction (questionnaire)
Time Frame: day 0, day 2, day 4 and day 6
day 0, day 2, day 4 and day 6

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Assiut University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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 (Estimated)

December 1, 2025

Primary Completion (Estimated)

December 1, 2026

Study Completion (Estimated)

April 1, 2027

Study Registration Dates

First Submitted

April 16, 2025

First Submitted That Met QC Criteria

April 26, 2025

First Posted (Actual)

May 6, 2025

Study Record Updates

Last Update Posted (Actual)

May 6, 2025

Last Update Submitted That Met QC Criteria

April 26, 2025

Last Verified

April 1, 2025

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • RIBFRACTURE

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

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.

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