Comparison of Dexmedetomidine Versus Dexamethasone as Adjuvants to Bupivacaine in Ultrasound-Guided Erector Spinae Plane Block for Acute Pain Management in Patients With Traumatic Rib Fractures
14. september 2026 oppdatert av: Mohamed Elsayed Ali Ibraheim, Assiut University
Comparison of Dexmedetomidine Versus Dexamethasone as Adjuvants to Bupivacaine in Ultrasound-Guided Erector Spinae Plane Block for Acute Pain Management in Patients With Traumatic Rib Fractures: A Prospective Randomized Double-Blind Controlled Study
Traumatic rib fractures cause severe chest wall pain that can impair normal breathing, coughing, and lung function. While systemic opioids are commonly used to treat traumatic pain, their side effects, such as sedation and respiratory depression, can complicate recovery. Regional nerve blocks like the ultrasound-guided erector spinae plane block (ESPB) offer targeted pain relief while minimizing opioid requirements.
The purpose of this clinical trial is to compare the analgesic efficacy and respiratory outcomes of adding dexmedetomidine versus dexamethasone to bupivacaine during an ultrasound-guided ESPB in emergency department patients with acute traumatic rib fractures.
Participants aged 18 to 65 years presenting within 24 hours of rib injury will be randomly assigned to one of two groups:
- Dexmedetomidine Group: Receives an ultrasound-guided ESPB with bupivacaine plus dexmedetomidine.
- Dexamethasone Group: Receives an ultrasound-guided ESPB with bupivacaine plus dexamethasone.
The primary outcome is the duration of analgesia, measured as the time to the first request for rescue pain medication. Secondary outcomes include pain scores at rest and during coughing/deep breathing, total 24-hour opioid consumption, diaphragmatic motion evaluated by ultrasound, respiratory recovery, and the incidence of adverse events over a 24-hour follow-up period.
Studieoversikt
Status
Har ikke rekruttert ennå
Forhold
Intervensjon / Behandling
Studietype
Intervensjonell
Registrering (Antatt)
100
Fase
- Fase 2
- Fase 3
Deltakelseskriterier
Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
- Voksen
- Eldre voksen
Tar imot friske frivillige
Nei
Beskrivelse
Inclusion Criteria:
- Adult patients aged 18 to 65 years
- Both sexes
- American Society of Anesthesiologists (ASA) physical status I-II
- Acute traumatic rib fractures confirmed by appropriate imaging
- Flail-chest patients who are hemodynamically and respiratory stable to undergo erector spinae plane block (ESPB) and reliable assessment
- Spontaneously breathing patients or patients receiving supplemental oxygen/non-invasive respiratory support without an immediate indication for intubation
- Ability to report pain using a Numeric Rating Scale (NRS)
- Presentation within 24 hours of trauma
- Ability to provide written informed consent
Exclusion Criteria:
- Patient refusal to participate
- Immediate need for endotracheal intubation or invasive mechanical ventilation prior to randomization or block placement
- Hemodynamic instability requiring immediate resuscitation or vasopressor support precluding safe regional anesthesia
- Cardiorespiratory arrest or peri-arrest status
- Severe associated traumatic brain injury or other injuries preventing reliable clinical evaluation
- Major associated injury requiring immediate emergency operative or interventional procedures that prevent protocol completion
- Coagulopathy or any contraindication to regional anesthesia
- Local infection at the anticipated block needle insertion site
- Known allergy to amide local anesthetics, dexmedetomidine, or dexamethasone
- Significant bradyarrhythmia, high-grade atrioventricular block, or contraindication to dexmedetomidine
- Chronic opioid consumption or chronic pain syndromes requiring regular analgesic therapy
- Prior regional anesthesia performed for the current trauma
- Inability to cooperate with the procedure or pain evaluation
Studieplan
Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Firemannsrom
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
|---|---|
|
Aktiv komparator: Dexmedetomidine Group
Participants receive an ultrasound-guided erector spinae plane block (ESPB) with bupivacaine plus dexmedetomidine (0.5 mcg/kg) following local skin infiltration with 5 mL of 2% lidocaine.
|
Ultrasound-guided thoracic erector spinae plane block (ESPB) administered deep to the erector spinae muscle and superficial to the transverse process (typically T4-T6) using bupivacaine supplemented with dexmedetomidine (0.5 mcg/kg) following local skin infiltration with 5 mL of 2% lidocaine.
|
|
Aktiv komparator: Dexamethasone Group
Participants receive an ultrasound-guided erector spinae plane block (ESPB) with bupivacaine plus dexamethasone (4 mg) following local skin infiltration with 5 mL of 2% lidocaine.
|
Ultrasound-guided thoracic erector spinae plane block (ESPB) administered deep to the erector spinae muscle and superficial to the transverse process (typically T4-T6) using bupivacaine supplemented with dexamethasone (4 mg) following local skin infiltration with 5 mL of 2% lidocaine.
|
Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
Time to First Rescue Analgesic Request
Tidsramme: Up to 24 hours post-block
|
Time (in minutes) from the completion of the ultrasound-guided erector spinae plane block until the patient's first request for rescue analgesia (or when the Numeric Rating Scale score is 4 or greater).
|
Up to 24 hours post-block
|
Samarbeidspartnere og etterforskere
Det er her du vil finne personer og organisasjoner som er involvert i denne studien.
Sponsor
Studierekorddatoer
Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.
Studer hoveddatoer
Studiestart (Antatt)
1. oktober 2026
Primær fullføring (Antatt)
1. oktober 2027
Studiet fullført (Antatt)
1. november 2027
Datoer for studieregistrering
Først innsendt
14. september 2026
Først innsendt som oppfylte QC-kriteriene
14. september 2026
Først lagt ut (Faktiske)
18. september 2026
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
18. september 2026
Siste oppdatering sendt inn som oppfylte QC-kriteriene
14. september 2026
Sist bekreftet
1. september 2026
Mer informasjon
Begreper knyttet til denne studien
Nøkkelord
Ytterligere relevante MeSH-vilkår
- Smerte
- Nevrologiske manifestasjoner
- Sår og skader
- Brudd, bein
- Thoracale skader
- Patologiske tilstander, tegn og symptomer
- Tegn og symptomer
- Akutt smerte
- Ribbbrudd
- Organiske kjemikalier
- Heterocykliske forbindelser, 1-ring
- Heterocykliske forbindelser
- Azoler
- Polysykliske forbindelser
- Imidazoles
- Anilider
- Amides
- Anilinforbindelser
- Aminer
- Gravadienes
- Gravaner
- Steroider
- Smeltede ringforbindelser
- Steroider, fluorert
- Gravadienetrioler
- Deksametason
- Bupivakain
- Dexmedetomidin
Andre studie-ID-numre
- Dexmedetomidine vs Dex in ESPB
Legemiddel- og utstyrsinformasjon, studiedokumenter
Studerer et amerikansk FDA-regulert medikamentprodukt
Nei
Studerer et amerikansk FDA-regulert enhetsprodukt
Nei
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