Vital Capacity in Ultrasound Guided Serratus Plane Block in ED Patients With Multiple Rib Fractures
Status:
Not yet recruiting
Trial end date:
2022-12-31
Target enrollment:
Participant gender:
Summary
I. Background:
Patients with multiple rib fractures are challenging from both pulmonary and analgesia
perspectives. Adequate pain management is essential in prevention of complications secondary
to decreased inspiratory volume. Significant morbidity and mortality of rib fractures is
secondary to severe pain that limits ribcage movement, decreases inspiratory volumes and
causes inadequate cough. Decreased vital capacity predisposes patients to atelectasis,
abnormal mucous clearance and pneumonia. The objective of this study is to assess the
efficacy of the serratus anterior plane block (SAPB) in improvement of vital capacity in
patients with multiple unilateral rib fractures when compared to conventional management with
medications. Currently, evidence of efficacy of SAPB in managing pain secondary to multiple
rib fractures is limited to case reports and series, none of which evaluate vital capacity.
II. Significance:
The findings of this study may indicate that SAPB is superior to pharmacological management
in increasing vital capacity in patients with multiple unilateral rib fractures and suggest
SAPB for first line therapy in patients with rib fractures. The findings may decrease the
risk of pulmonary complications as well as the use of opiates in management of multiple rib
fractures in the Emergency Department especially in patients with numerous comorbidities and
contraindications to conventional treatment modalities. This study may support the need for
training emergency medicine physicians in bedside SAPB in order to provide the optimal
therapy for patient with multiple unilateral rib fractures.
III. Study Objectives:
The primary objectives are to evaluate whether ultrasound guided SAPB results in a greater
improvement in percent predicted vital capacity compared to standard therapy with a sham
injection. The investigators will also evaluate pain scores and the safety profile of the
SAPB procedure compared to those receiving standard analgesia.
IV. Hypothesis:
The primary hypothesis is that SAPB is superior to sham injection in improving the percent of
predicted vital capacity. The secondary hypothesis is that SAPB will have greater improvement
in pain scores and have a superior safety profile compared to placebo injection.