Clinical trial NCT06088836: Ultrasound- Guided Continuous Retro Laminar Block Versus Continuous Erector Spinae Plane Block in Multiple Rib Fractures
Official title: Impact of Ultrasound- Guided Continuous Retro Laminar Block Versus Continuous Erector Spinae Plane Block on Incentive Spirometry Volumes and Pain Scores in Multiple Rib Fractures
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Retrolaminar Block
Erector Spinae Plane Block
Spirometry
Pain
Multiple Rib Fractures
Lead sponsor: Tanta University
Sponsor class: OTHER
First posted: 2023-10-18
Enrollment: 60
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The aim of this study is to compare the incentive spirometry volume and analgesic efficacy of ultrasound guided continuous Retrolaminar block and continuous Erector spinae plain block in patients with multiple rib fractures.

Detailed description: Thoracic epidural analgesia (TEA) and thoracic paravertebral block (TPVB) are strongly recommended techniques for managing thoracic neuropathic pain However, they can be technically challenging to perform and are associated with up to 15% failure rate in Thoracic epidural analgesia (TEA)and potential risk of pneumothorax in thoracic paravertebral block (TPVB).Newer approaches have been the focus of many studies in recent years; these approaches include retrolaminar block and erector spinae plane block.

Retrolaminar block (RLB) is a new thoracic truncal block for controlling somatic pain in both the thoracic and abdominal walls.

The Erector Spinae plane block (ESPB) has been used successfully to manage severe neuropathic pain arising from ribs .The basis to use ESPB is its likely site of action which is the dorsal and ventral rami of the thoracic spinal nerves.

Eligibility criteria: Inclusion Criteria:

* Age from 18 to 65 years old.
* Both sexes.
* Patients with unilateral multiple traumatic rib fractures (≥ 3 ribs).

Exclusion Criteria:

* 1st ken refusal.
* Patients with any contraindication for regional block as:

  * Bleeding disorders.
  * Infection at the injection site.
  * Patients with hemodynamic instability.
* Patients with known hypersensitivity to the study drugs
* Unconscious patients
* Patients with significant trauma outside the chest wall e.g., acute spine or pelvic fracture, severe traumatic brain or spinal cord injury, or abdominal visceral injuries
* Patients with significant lung contusions, pneumothorax, flail chest
* Chronic opioid users.
* Uncooperative patients and patients with psychiatric illness

Primary outcomes:
measure: Maximum inspired volume
timeFrame: 4 days after intervention.
Secondary outcomes:
measure: Daily and total rescue analgesics consumption.
timeFrame: 24 hours after intervention.
measure: Intensive care length of stay.
timeFrame: 28 days after intervention
measure: Hospital length of stay.
timeFrame: 28 days after intervention
measure: pH
timeFrame: 4 days after intervention.
measure: PaO2
timeFrame: 4 days after intervention.
measure: PaCo2
timeFrame: 4 days after intervention.
measure: FiO2
timeFrame: 4 days after intervention.
measure: Respiratory rate
timeFrame: 4 days after intervention.
measure: Adverse effects and complications.
timeFrame: 4 days after intervention.
Other outcomes:
Locations:
city: Tanta
country: Egypt
facility: Tanta University
state: El-Gharbia
Study officials:
References: