Ultrasound-guided Deep Versus Superficial Continuous Serratus Anterior Plane Block for Pain Management in Patients With Multiple Rib Fractures
- Conditions
- Multiple Rib FracturesPain, AcuteSerratus Anterior Plane Block
- Interventions
- Procedure: Ultrasound-guided continuous serratus anterior plane block
- Registration Number
- NCT04575272
- Lead Sponsor
- Assiut University
- Brief Summary
The present clinical study will be undertaken to evaluate the effect of Ultrasound-guided Deep versus Superficial continuous Serratus Anterior Plane Block for pain management in patients with multiple rib fractures.
- Detailed Description
Thoracic blunt trauma, especially when multiple rib fractures are associated, is challenging to manage and causes significant morbidity due to the severe pain implied.
Patients can present with respiratory compromise as their capacity to expand the thorax is limited by pain. As a result, they are at high risk to develop atelectasis and pneumonia.
the key goal of management is adequate analgesia and pulmonary volume expansion Various strategies to treat such pain have been utilized, including regional analgesia (intrapleural, intercostal paravertebral nerve blockade), and neuraxial analgesia (thoracic epidural analgesia (TEA), intrathecal opioids).
The use of neuraxial analgesia in polytrauma is frequently limited by the need for aggressive venous thromboembolic (VTE) prophylaxis, and positioning of the patient for a neuraxial approach may be impossible.
There is a growing interest in exploring treatments that are less invasive than EA and can be performed on patients who have contraindications to neuraxial analgesia. Ultrasound-guided Serratus Anterior Plane (SAP) block is a recent technique, first described by Blanco et al. in 2013, that provides analgesia for the thoracic wall by blocking the lateral branches of the intercostal nerves from T2 to L2. It is a safe, simple to perform block with no significant contraindications or side effects. he described 2 potential spaces, one superficial and another deep to serratus. The SAPB has been used effectively for the management of pain in the context of rib fractures, thoracoscopic surgery, thoracotomy, breast surgery, and post-mastectomy pain syndrome, few studies compared the two approaches, and the difference between them has not yet been studied in patients with multiple rib fractures.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 62
- Adult patients of either sex, having three or more unilateral fracture ribs and admitted to the trauma ICU, Rib fractures were confirmed by X-ray and CT scan reads.
- significant head injury and unconsciousness (GCS less than 14)
- Patients with significant pain from other injuries
- pathological obesity (body mass index ≥35)
- history of drug allergy local anesthetics
- local infection at the injection site
- inability to obtain consent from patient or surrogate, and patient refusal
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Continuous Superficial Serratus Anterior Plane Block group Ultrasound-guided continuous serratus anterior plane block at the level of the fifth rib in the mid-axillary line. After anaesthetizing the skin with 2 mL of lidocaine 2%, an 18-gauge Touhy needle was introduced in-plane, under direct visualization, to the plane immediately superficial to the serratus anterior muscle. After negative aspiration, 35 mL of bupivacaine 0.25% will be injected. Afterwards, a 20-gauge peripheral nerve catheter will be threaded into the space. then bupivacaine 0.125% infusion at a rate of 5 ml/h by an Infusion Syringe Pump will be started. Continuous Deep Serratus Anterior Plane Block group Ultrasound-guided continuous serratus anterior plane block at the level of the fifth rib in the mid-axillary line. After anaesthetizing the skin with 2 mL of lidocaine 2%, an 18-gauge Touhy needle was introduced in-plane, under direct visualization, to the plane immediately deep to the serratus anterior muscle. After negative aspiration, 35 mL of bupivacaine 0.25% will be injected. Afterwards, a 20-gauge peripheral nerve catheter will be threaded into the space. then bupivacaine 0.125% infusion at a rate of 5 ml/h by an Infusion Syringe Pump will be started.
- Primary Outcome Measures
Name Time Method Change in pain score before and after the block at "30 minutes", "2hours", "4hours", "6hours", "12hours", "24hours", "36hours", "48 hours" & "72hours" patient report numerical rating scale (NRS) 0 to 10, with 0 being "no pain" and 10 being "the worst pain imaginable"
- Secondary Outcome Measures
Name Time Method heart rate before and after the block every "2hours" for 3 days heart rate by EKG monitor
peripheral arterial oxygen saturation (SpO2) before and after the block every "2hours" for 3 days measured by Pulse oximetry
Change in inspiratory volumes (mL) before and after block at "90 minutes" then every "12hours" for 3 days Maximum inspiratory respiratory volume (measured in ml) recorded on single use of incentive spirometer device
change in Serum beta-endorphin level before procedure and at 24 hours post procedure We will use radioimmunoassays to measure plasma beta-endorphin level
mean arterial blood pressure before and after the block every "2hours" for 3 days mean arterial blood pressure by non invaisive blood pressure monitoring
Lung Ultrasound Score (LUSS) before and after block at "90 minutes" then every "24 hours" for 3 days We will use a techniques based on the international evidence-based recommendations for point-of-care lung ultrasound that recommended using a complete eight-zone lung ultrasound ,The worst ultrasound pattern observed in each zone was recorded and used to calculate the sum of the scores (total score = 24).
Trial Locations
- Locations (1)
Assiut University
🇪🇬Assiut, Egypt