Clinical trial NCT06093776: Rib Fracture Cryoanalgesia
Official title: Rib Fracture Cryoanalgesia
Study type: OBSERVATIONAL
Overall status: RECRUITING
Conditions: Pain Management Improvement
Lead sponsor: Methodist Health System
Sponsor class: OTHER
Collaborators: name: Pacira Pharmaceuticals, Inc
First posted: 2023-10-23
Enrollment: 10
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: CASE_ONLY
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: ≥18 years of age Acute pain attributed to rib fracture(s) Able to obtain consent

Brief summary: Rib fractures lead to poor patient outcomes and even death 3. Data suggests effective pain management is crucial to obtain favorable outcomes 4, 5Current outpatient treatment modalities are limited to oral or topical medications with low efficacy and high risk for opioid dependence. In-patient management with a thoracic epidural TEA is largely considered the gold standard, but the risks of TEA may outweigh the benefits 6 to 8.

Detailed description: Methodist Dallas Medical Center MDMC is an urban Level I Trauma Center that manages over 200 rib fracture cases annually. MDMC has a history of developing and using innovative analgesia techniques aimed at improving outcomes. In 2010 we first described the need for advancements in the treatment of rib fracture patients 1. Later, we validated the technique that is now used at hundreds of trauma centers around the world 2. Our surgical and research teams have a history of advocating for optimal management of rib fracture pain in order to prevent serious complications.

This study will seek to describe the effective use of cryoanalgesia as a feasible method of pain management in the rib fracture patient. With a small cohort and case series, we will describe and refine the procedure and preliminary efficacy of the FDA-approved iovera system in adult rib fracture patients. In order to ethically assess the clinical relevance of the iovera system, our objective will be accomplished by completing a case series

Eligibility criteria: Inclusion Criteria:

* 18 years of age Acute pain attributed to rib fracture(s) Able to obtain consent

Exclusion Criteria:

* \<18 years of age Pregnant Incarcerated Confounding injuries or significant pain attributed to secondary injury Patients with any of the following: cryoglobulinemia; paroxysmal cold hemoglobinuria; cold urticarial; Raynaud's disease; open and/or infected wounds at or near the treatment site

Primary outcomes:
measure: Pain Assessment
timeFrame: 14 days
Secondary outcomes:
measure: Demographics
timeFrame: 30 days
Other outcomes:
Locations:
city: Dallas
country: United States
facility: Methodist Dallas Medical Center
state: Texas
Study officials:
References:
citation: Truitt MS, Mooty RC, Amos J, Lorenzo M, Mangram A, Dunn E. Out with the old, in with the new: a novel approach to treating pain associated with rib fractures. World J Surg. 2010 Oct;34(10):2359-62. doi: 10.1007/s00268-010-0651-9.
citation: Truitt MS, Murry J, Amos J, Lorenzo M, Mangram A, Dunn E, Moore EE. Continuous intercostal nerve blockade for rib fractures: ready for primetime? J Trauma. 2011 Dec;71(6):1548-52; discussion 1552. doi: 10.1097/TA.0b013e31823c96e0.
citation: Ibrahim-Zada I, Bell MT, Campion EM, Pieracci FM, Truitt MS. Delayed presentation of pulmonary hernia following surgical stabilization of severe rib fractures. J Trauma Acute Care Surg. 2016 Aug;81(2):397-9. doi: 10.1097/TA.0000000000001102. No abstract available.
citation: Beard L, Holt B, Snelson C, Parcha C, Smith FG, Veenith T. Analgesia of Patients with Multiple Rib Fractures in Critical Care: A Survey of Healthcare Professionals in the UK. Indian J Crit Care Med. 2020 Mar;24(3):184-189. doi: 10.5005/jp-journals-10071-23375.
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citation: Carrier FM, Turgeon AF, Nicole PC, Trepanier CA, Fergusson DA, Thauvette D, Lessard MR. Effect of epidural analgesia in patients with traumatic rib fractures: a systematic review and meta-analysis of randomized controlled trials. Can J Anaesth. 2009 Mar;56(3):230-42. doi: 10.1007/s12630-009-9052-7. Epub 2009 Feb 11.
citation: McKendy KM, Lee LF, Boulva K, Deckelbaum DL, Mulder DS, Razek TS, Grushka JR. Epidural analgesia for traumatic rib fractures is associated with worse outcomes: a matched analysis. J Surg Res. 2017 Jun 15;214:117-123. doi: 10.1016/j.jss.2017.02.057. Epub 2017 Mar 6.
citation: Sheets NW, Davis JW, Dirks RC, Pang AW, Kwok AM, Wolfe MM, Sue LP. Intercostal Nerve Block with Liposomal Bupivacaine vs Epidural Analgesia for the Treatment of Traumatic Rib Fracture. J Am Coll Surg. 2020 Jul;231(1):150-154. doi: 10.1016/j.jamcollsurg.2019.12.044. Epub 2020 Feb 17.
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citation: Cadaval Gallardo C, Martinez J, Bellia-Munzon G, Nazar M, Sanjurjo D, Toselli L, Martinez-Ferro M. Thoracoscopic cryoanalgesia: A new strategy for postoperative pain control in minimally invasive pectus excavatum repair. Cir Pediatr. 2020 Jan 20;33(1):11-15. English, Spanish.
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citation: Farley P, Griffin RL, Jansen JO, Bosarge PL. Quantifying Pain Associated With Rib Fractures. J Surg Res. 2020 Feb;246:476-481. doi: 10.1016/j.jss.2019.09.032. Epub 2019 Oct 24.
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