Continuous Erector Spinae Plane Blocks for Rib Fractures

• Status: Recruiting
• Trial end date: 2023-12-01
• Target enrollment: 0
• Participant gender: All

Summary

Rib fractures are one of the most common injuries in trauma patients. These fractures are associated with significant pain as well as decreased ability to inspire deeply or cough to clear secretions, which together lead to complications of the lungs and breathing which leads to risks of further injury and even death.

One recent study found that the ability to move air into and out of the lungs practically doubled with the administration of a single-injection Erector Spainae Plane Block (ESPB) while pain levels nearly halved. However, a single-injection nerve block lasts less than 24 hours while a perineural local anesthetic infusion (also termed a "continuous peripheral nerve block") may be administered for multiple days. This entails inserting a tiny tube through the skin and into the area around the nerves, after which more local anesthetic may be administered prolonging the numbing effects.

The possibility of extending the duration of a ESPB with local anesthetic administration via a perineural catheter has not be investigated. We therefore are conducting a randomized, triple-masked, placebo-controlled, parallel-arm study to investigate the addition of a continuous ESPB to a single-injection ESPB following traumatic rib fractures.

The primary outcome of this study will be the maximum inspired volume measured by incentive spirometry on the afternoon following the nerve block procedure. We hypothesize that the maximum inspired volume will be significantly increased in the afternoon following the procedure with the addition of a continuous ESPB to a single-injection ESPB.

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: University of California, San Diego
• Treatments: Ropivacaine

Criteria

Inclusion Criteria:

• having a total of 1-6 rib fractures at least 3 cm distal to the costo-transverse joint (bilateral fractures are acceptable, but the total of the two sides combined must not exceed 6 fractures)

• regional anesthetic requested by the admitting service

• patient accepting of a perineural catheter insertion and subsequent study fluid treatment.

Exclusion Criteria:

• chronic opioid use (daily use within the 2 weeks prior to presentation and duration of use > 4 weeks; of note, any testing for opioid use will not occur as part of the study, but may as standard of care)

• pregnancy

• incarceration

• inability to communicate with the investigators

• weight < 45 kg or morbid obesity (body mass index > 40 kg/m2)

• comorbidity precluding either perineural catheter insertion or subsequent ambulatory perineural local anesthetic administration (e.g., current infection at the catheter insertion site, known hepatic or renal insufficiency, immune-compromised status of any etiology)

• any patient unable to correctly perform incentive spirometry as this is the primary outcome measure

• any patient with any degree of decreased mental capacity as determined by the surgical service

• any reason an investigator believes study participation would not be in the best interest of the potential subject

• flail chest

• chest tube

• fracture of the 1st rib on either side

• any injury other than the rib fracture(s) that potentially effects inspiratory effort or volume (e.g., clavicle fracture)

• inability to contact the investigators during the perineural administration, and vice versa (e.g., lack of telephone access).