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.
研究概览
详细说明
研究类型
注册 (预期的)
阶段
- 不适用
联系人和位置
学习联系方式
- 姓名:Dana Sajed
- 电话号码:858 361 4685
- 邮箱:sajed@usc.edu
参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
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
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
实验性的:ESPB Block
Patients with rib fracture randomized to block group
|
Nerve block with local anesthetic in the erector spinae plane
其他名称:
|
有源比较器:Standard Care
Patients with rib fracture receiving IV analgesia/standard care
|
IV analgesia, typically Morphine/Opioid medications
其他名称:
|
研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
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
大体时间: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
|
合作者和调查者
调查人员
- 首席研究员:Tom Mailhot, MD、LAC+USC Medical Center
研究记录日期
研究主要日期
学习开始 (预期的)
初级完成 (预期的)
研究完成 (预期的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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