Management of Multiple Rib Fractures; Role of Nerve Block
试验速览
- 阶段
- 4 期
- 状态
- 尚未招募
- 入组人数
- 74
- 主要终点
- Improvement in patients pain score (neumerical score)
研究概览
简要总结
- Epidemiology & Impact Thoracic trauma is a common and serious injury worldwide-especially in developing countries-and carries high rates of morbidity and mortality. Complications arise primarily from hypoventilation, which leads to atelectasis, pneumonia, and respiratory failure.
- Key to Reducing Complications: Pain Control Effective analgesia is the cornerstone of preventing respiratory complications. Inadequate pain relief causes patients to splint and hypoventilate, setting the stage for pulmonary collapse and infection.
- Conservative Management
- Analgesics: Systemic pharmacological pain relief remains the mainstay.
- Supportive Measures: Rest, application of ice, and encouragement of deep breathing exercises.
- Incentive Spirometry: Promoted in all patients to maintain lung expansion and ward off atelectasis.
- Regional Anesthesia Techniques
To further improve comfort and respiratory mechanics, ultrasound-guided nerve blocks are employed according to fracture location:
- Serratus Anterior Plane Block for anterolateral rib fractures
- Thoracic Paravertebral Block for posterior rib fractures
- Surgical Intervention Reserved for complex cases-such as flail chest or fractures with risk of organ injury-where stabilization or repair may be necessary.
- Identified Gap Despite these options, thoracic surgeons currently lack a standardized, procedure-specific pain management protocol beyond systemic analgesics, highlighting a need for consensus guidelines that integrate pharmacological and regional techniques.
详细描述
Thoracic trauma is a major traumatic injury throughout the world, and it has very high incidence in developing countries. Thoracic trauma is often associated with significant morbidity and mortality. Morbidity is due to atelectasis, pneumonia, and respiratory failure as a sequence of hypoventilation.
Most important factor in preventing complications in these patients is pain management. There are different lines of management of multiple rib fractures; conservative therapy is a common line of management which includes appropriate analgesic, rest, and ice.
The use of an incentive spirometer should be encouraged to prevent pulmonary atelectasis and splinting.
Nerve block can also be applied to aid in pain control, surgery may also be a line of management for complicated cases.
The type of nerve block differs according to the site of the fracture; Ultrasound-Guided Serratus Anterior Plane Block is often used for anterolateral rib fractures and Ultrasound-Guided Thoracic Paravertebral Block is used for posterior rib fractures.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 70 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •All trauma adult patient (18-70 years) with multiple fracture ribs
排除标准
- •Patient with multiple fracture rib with anterior flail segment
- •Significant head trauma
研究组 & 干预措施
nerve block
干预措施: Nerve block with Lidocain (Procedure)
pharmacological analgesics
干预措施: pharmacological analgesics (Drug)
结局指标
主要结局
Improvement in patients pain score (neumerical score)
时间窗: day 0, day 1 and day 3
次要结局
- improving intercostal tube duration in days(day 2, day 4 and day 6)
- improving total hospital stay in days(day 2, day 4 and day 6)
- improving patient satisfaction (questionnaire)(day 0, day 2, day 4 and day 6)
研究者
Mostafa Kotb
Principal Investigator
Assiut University