- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT04892563
Erector Spinae Plane Block for Rib Fracture Analgesia in the Emergency Department
Rib fractures, while in isolation are self-limited and benign, can be exquisitely painful. Poorly controlled rib fracture pain can compromise respiratory function leading to increased morbidity and mortality, especially in the elderly. Currently, opioid medications are the mainstay of analgesia but are associated with significant adverse effects, such as respiratory depression and delirium. In an effort to improve acute pain in the ED and concomitantly reduce opioid use, ultrasound-guided regional anesthesia has been implemented more frequently The erector spinae plane block (ESPB) is a relatively new ultrasound-guided procedure for thoracic analgesia.
Previously, the serratus anterior plane (SAP) block has been used for this indication. However, typical anatomical distribution limits the effectiveness of the SAP block to anterior rib fractures, while the majority of traumatic rib fractures are posterior, thus require a more central blockade such as the proposed ESPB. The ESPB can be done as a single injection into the superficial structures of the back under ultrasound guidance and as such, is a both a relatively safe and technically easy procedure to perform, especially in comparison to the more traditional alternatives of epidurals, paravertebral and intercostal injections.
There have been no prospective studies evaluating the efficacy and safety of the ESPB in the emergency department setting for acute rib fractures. The investigators hypothesize that the ESPB will provide improved acute pain scores in the emergency department compared to parental analgesia alone. Secondarily, investigators hypothesize that this will translate to less inpatient opioid requirements and improved incentive spirometry values.
Studieoversikt
Status
Forhold
Intervensjon / Behandling
Detaljert beskrivelse
Studietype
Registrering (Forventet)
Fase
- Ikke aktuelt
Kontakter og plasseringer
Studiekontakt
- Navn: Dana Sajed
- Telefonnummer: 858 361 4685
- E-post: sajed@usc.edu
Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
Beskrivelse
Inclusion Criteria:
- Age >=18
- At least 1 acute rib fracture. Acute defined as within 7 days of presentation.
- Numerical pain score on presentation at least 5 out of 10. This will identify patients that justify the invasive procedure.
- Admitted to hospital for at least 24 hours of observation.
- Be able to consent and participate in study by assuming necessary positioning for intervention
Exclusion Criteria:
- Hypotension/shock (shock index >1.0, SBP < 90)
- Distracting injury not amenable to ESPB as determined by the enrolling physician. (i.e extremity fracture, burn, laceration, contusion, joint dislocation, etc.)
- Examples of patients not able to consent/participate are intubated patients or patients in spinal precautions (i.e c-collar)
- Known hypersensitivity to local anesthetic
- Evidence of infection at the proposed site of injection
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
---|---|
Eksperimentell: ESPB Block
Patients with rib fracture randomized to block group
|
Nerve block with local anesthetic in the erector spinae plane
Andre navn:
|
Aktiv komparator: Standard Care
Patients with rib fracture receiving IV analgesia/standard care
|
IV analgesia, typically Morphine/Opioid medications
Andre navn:
|
Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
To determine the effectiveness of the ESPB for pain management of acute rib fractures in the emergency department using a 10 point isual analog scale
Tidsramme: 0, 1, 2 and 24 hours assessment
|
Change in pain level from fractures as measured using a visual analog scale
|
0, 1, 2 and 24 hours assessment
|
Samarbeidspartnere og etterforskere
Etterforskere
- Hovedetterforsker: Tom Mailhot, MD, LAC+USC Medical Center
Studierekorddatoer
Studer hoveddatoer
Studiestart (Forventet)
Primær fullføring (Forventet)
Studiet fullført (Forventet)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Faktiske)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
- Patologiske prosesser
- Sår og skader
- Sykdomsattributter
- Thoracale skader
- Flere traumer
- Nødsituasjoner
- Brudd, bein
- Ribbbrudd
- Brudd, multiple
- Fysiologiske effekter av legemidler
- Sentralnervesystemdepressiva
- Agenter fra det perifere nervesystemet
- Analgetika
- Sensoriske systemagenter
- Analgetika, opioid
- Narkotika
- Morfin
Andre studie-ID-numre
- HS-21-00066
Plan for individuelle deltakerdata (IPD)
Planlegger du å dele individuelle deltakerdata (IPD)?
Legemiddel- og utstyrsinformasjon, studiedokumenter
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Charles University, Czech RepublicFullførtMuskelhypertoni | Rib syndromTsjekkia
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Kliniske studier på Erector Spinae Plane Block
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Ankara UniversityThe Scientific and Technological Research Council of TurkeyFullførtThorakotomi | Forebyggende analgesi | Erector Spina Plan Block | Nociception Level Index (NoL)Tyrkia
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