A Retrospective Review of Rib Fracture Pain Management at a London Major Trauma Centre Comparing Erector Spinae Plane Blocks, Serratus Anterior Plane Blocks and Epidurals
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 389
- 试验地点
- 1
- 主要终点
- The Proportion of Patients With a Reduction in Pain
研究概览
简要总结
Thoracic epidural analgesia (TEA) is widely considered to be the current gold standard treatment for rib fracture pain and is used in the Imperial invasive treatment pathway for rib fractures. However, TEA are often contraindicated due to other injuries or the use of anticoagulant medications, which also contraindicates other invasive nerve block techniques e.g. paravertebral catheters. A number of case reports have reported the safe use of alternative techniques such as Serratus Anterior Blocks (SAPB) and Erector Spinae Blocks (ESPB) and the anaesthesia community has taken them up widely based on this relatively limited evidence. In view of this, Womack et al recently published a large retrospective review examining the safety and efficacy of ultrasound guided paravertebral catheter analgesia techniques in rib fracture management along with small numbers of ESPBs. However, this data did not report the analgesic efficacy, patient reported pain relief or respiratory complications.The goal is to advance this body of evidence by reviewing our larger data set concerning the use of TEA and alternative regional techniques such as ESPB and SAPB. This comprehensive review will benefit patients by documenting the efficacy and safety of these techniques for clinicians managing rib fracture patients.
详细描述
Primary Objective The primary objective is to examine whether novel fascial plane blocks, e.g. SAPB and ESPB, are effective pain relief modalities in patients with rib fractures - the proportion of patients with a reduction in pain.
Secondary Objectives
The investigators review the safety profile and complications of TEA and alternative analgesic techniques such as ESPB and SAPB used for rib fracture management in our trauma centre. In particular the effects of regional anaesthesia techniques on:
- Opioid use
- Nausea & vomiting
- Respiratory complications
- Intubation & non-invasive ventilation (NIV)
- ICU admission for respiratory complications
The investigators will assess the duration of use and complication profile of regional anaesthetic techniques, including infection, analgesic failure and damage to other structures during insertion e.g. the lung.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients aged > 18 years of age presenting with traumatic rib fractures in a major trauma centre over the past 5 years
- •Meet the criteria for the Imperial College Healthcare NHS Trust 'Invasive rib fracture management pathway'
排除标准
- •Under 18 years old
- •Prisoners
- •Private patients
- •Meet the criteria for the Imperial College Healthcare NHS Trust 'Non-invasive rib fracture management pathway'
结局指标
主要结局
The Proportion of Patients With a Reduction in Pain
时间窗: 72 hours
The investigators will review pain scores as recorded by clinical staff over 72 hours to assess pain relief efficacy, A verbal rating scale classifying pain as mild, moderate or severe is used at Imperial Data from the acute pain round records will also provide details regarding breathing comfort levels of the patient, coughing ability and deep inspiratory effort. These are recorded as yes/no answers and the team will assess the proportion of patients showing a reduction in pain scores.
次要结局
- Opioid Consumption (mg/24h)(72 hours)
- Nausea and Vomiting(72 hours post block)
- Number of Patients With Respiratory Complication(s)'(Length of stay up to 8 weeks)
- Intensive Care Admission(Length of stay up to 8 weeks in days)
- Number of Days of Mechanical Ventilation(Length of stay up to 8 weeks in days)