Ultrasound- Guided Continuous Serratus Anterior Plane Block Versus Ultrasound- Guided Continuous Thoracic Paravertebral Block in Multiple Traumatic Rib Fractures.

Study Overview
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Brief Summary
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The aim of this study is to compare the analgesic efficacy of ultrasound guided continuous SAP block and ultrasound guided continuous TPVB in patients with multiple traumatic rib fractures.

Official Title
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Ultrasound- Guided Continuous Serratus Anterior Plane Block Versus Ultrasound- Guided Continuous Thoracic Paravertebral Block For Analgesia in Multiple Traumatic Rib Fractures.

Conditions
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Serratus Anterior Plane Block, Thoracic Paravertebral Block, Ultrasound, Multiple Traumatic Rib Fractures, Analgesia

Intervention / Treatment
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* Procedure: Thoracic paravertebral block
* Procedure: Serratus anterior plane block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients of either gender aged between 22-65 years with unilateral traumatic multiple fracture ribs (≥ 3 fractured ribs). Exclusion Criteria: • Contraindications to regional block such as patient's refusal, coagulopathy, local infection at the site of the block, known allergy to local anesthetic drugs and spinal deformity. Patients suffer from severe cardiovascular disease, hepatic or renal disease and patients with history of psychiatric illness. Patients had indications for mechanical ventilation on admission or during the study period. Patients had indications for immediate surgery for other associated injuries. Patients with hemodynamic instability. Patients having spine or pelvic fracture, traumatic brain injury, altered conscious level or spinal cord injury.

Ages Eligible for Study
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Minimum Age: 22 Years
Maximum Age: 65 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: Thoracic paravertebral block<br>Patients will receive ultrasound-guided continuous thoracic paravertebral blockusing bupivacaine 0.25% for 4 days. | Procedure: Thoracic paravertebral block<br>* A bolus dose of 0.25% bupivacaine (0.3 ml/kg) will be injected slowly over 3-5 minutes. At 30 minutes after injection of the loading dose, the dermatomal loss of sensation to pinprick was tested. Patients who reported pain to pinprick will be considered to have a failed block and were excluded from the study. The block will be maintained by continuous infusion of bupivacaine 0.25% at a rate of 0.1 ml/kg/h via a syringe pump. The infusion will be continued for 4 days.<br>|
| Experimental: Serratus anterior plane block<br>Patients will receive ultrasound-guided continuous SAP block using bupivacaine 0.25% for 4 days. | Procedure: Serratus anterior plane block<br>* A bolus of 30 ml of 0.25% bupivacaine will be injected slowly over 3-5 minutes between latissmus dorsi muscle and serratus anterior muscle (Figure 15). Then a catheter was inserted through the Tuohy needle and advanced 3cm into the space and secured in place. At 30 minutes after injection of a loading dose, the dermatomal loss of sensation to pinprick will be tested. Patients who reported pain to pinprick will be considered to have a failed block and were excluded from the study. The block will be maintained by continuous infusion of bupivacaine 0.25% at a rate of 0.1 ml/kg/h via a syringe pump. The infusion was continued for 4 days.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Degree of pain scores | Pain will be assessed at rest and on coughing using the VAS on a scale from 0 (no pain) to 100 (worst pain) before the block, 30 minutes, 60 minutes after the block, and then every six hours for 4 days. But in order not to interrupt the sleeping pattern of patients, patients will be considered pain free (VAS= 0) if they will be at sleep with no tachypnea, tachycardia, or hypertension. | Four days after the block | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total consumption of morphine | Rescue analgesia will be provided with morphine (0.05 mg/kg) intravenously if visual analogue score (VAS) ≥ 40. | Four days after the block | 
| Changes of forced vital capacity (FVC) | Forced vital capacity (FVC) will be assessed using bedside spirometry before the block, 30 minutes, 60 minutes after the blocks, and then every eight hours for 4 days | Four days after the block | 
| Changes of forced expiratory volume in one second (FEV1) | Forced expiratory volume in one second (FEV1) will be assessed using bedside spirometry before the block, 30 minutes, 60 minutes after the blocks, and then every eight hours for 4 days | Four days after the block | 
| Changes of forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) | FEV1/FVC ratio will be assessed using bedside spirometry before the block, 30 minutes, 60 minutes after the blocks, and then every eight hours for 4 days | Four days after the block | 
| Length of ICU stay | Length of ICU stay, defined as the time from admission to ICU to time of transfer to the surgical ward. | Four days after the block | 
| Length of hospital stay |  | Four days after the block | 
| Incidence of complications | Incidence of respiratory complications and mechanical ventilation | Four days after the block |