Serratus Plane Block for Rib Fractures

Study Overview
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Brief Summary
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Patients with ipsilateral multiple rib fractures will be randomized to receive either a single-shot ultrasound-guided serratus plane block, or a continuous serratus plane block within 24h from the chest trauma. Primary outcome is the difference in forced respiratory volume (FEV1) at 72h.

Detailed Description
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Patients admitted in emergency department with a chest trauma and ipsilateral multiple rib fractures, will be randomized as described above. All patients will receive the serratus block with a ropivacaine 0.37% solution 20 ml. Then, they will randomized to receive either a peripheral catheter placed above the 5th rib on the middle axillary line, or nothing. In all patients postoperative analgesia also include Paracetamol 1g IV each 6h and a patient controlled analgesia (PCA) of morphine set out as follow: bolus 1 mg, loch out 15 min, max 4 boluses each hour. In all patients an arterial blood sample for gas analysis and a FEV1 will be achieved before the block, after 1 hour and at 72h.

Official Title
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Effect of the Serratus Plane Block on the Outcome in Patient With Multiple Rib Fractures: A Prospective, Randomized, Controlled Trial

Conditions
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Chest Trauma, Chest Pain

Intervention / Treatment
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* Procedure: Serratus plane block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 2 o more ipsilateral rib fractures Trauma within 24h from hospital admission Informed consent Exclusion Criteria: Chest drain head trauma bilateral rib fractures Intensive care admission

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: continuous<br>continuous local anesthetic infusion (ropivacaine 0.2%)on the serratus plane for at least 72h adds to a Single-shot serratus plane block with ropivacaine 0.37% solution 20 ml. | Procedure: Serratus plane block<br>* Local anesthetic infusion though a peripheral nerve catheter placed on the 5th rib under the serratus plane<br>|
| Active Comparator: single-shot<br>Single-shot serratus plane block with ropivacaine 0.37% solution 20 ml | Procedure: Serratus plane block<br>* Local anesthetic infusion though a peripheral nerve catheter placed on the 5th rib under the serratus plane<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pulmonary change function | FEV 1 | day 0 and day 3 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numerical rating scale (NRS) of pain | Pain both at rest and on movement on a 0-10 scale where 0 is the best and 10 the worst | day 0, day 1, day 2, day 3, day 4 | 
| Morphine | morphine requirement | day 0, day 1, day 2, day 3, day 4 | 
| hospital stay | time to fill the discharge criteria | day 1, day 2, day 3, day 4, day 5, day 6, day7 |