Serratus Plane Block With Parenteral Opioid Analgesia Versus Patient Controlled Analgesia in Rib Fractures

  • STATUS
    Recruiting
  • End date
    Jun 10, 2022
  • participants needed
    58
  • sponsor
    Chelsea and Westminster NHS Foundation Trust
Updated on 12 June 2021
analgesia
morphine
opioid
pain relieving

Summary

In this multicentre randomised controlled trial, adult patients with isolated chest trauma and two or more unilateral rib fractures will be randomised to either serratus plane block and patient controlled analgesia or patient controlled analgesia alone. Our primary outcome is the static visual analogue scale score at one hour.

Description

Rib breaks, or fractures, can cause pain that can be very difficult to manage and can result in chest infection and death. Such pain can be managed with either systemic drugs like morphine, which are given by mouth or through the veins, or local anaesthetic techniques, which can numb the painful area. Use of systemic drugs is however limited by significant side effects and traditional local anaesthetic techniques have problems of their own. Epidural analgesia, where local anaesthetic is placed near the spine, can only be done by those with a high level of technical skill and cannot be performed in patients with spine injuries, positioning difficulties and clotting problems. Complications and side effects can be common and/or serious and include failure, fall in blood pressure, and nerve and spinal cord damage. More recently, there has been interest in a new local anaesthetic technique, serratus plane block. Serratus plane block is simple to learn and can be done without any need for repositioning of the patient. It avoids some of the complications and side effects related to other local anaesthetic techniques and is more easily looked after by nursing staff on the ward. In view of this, we are aiming to recruit 44 adults with isolated chest injury and two or more rib fractures on one side. Each patient will either receive a serratus plane block in conjunction with morphine through the veins or just morphine alone. Our main aim is to assess how bad the pain is at 1 hour, but we will also compare the pain score, morphine consumption, lung function, level of sleepiness, and the frequency of low blood pressure, nausea and vomiting and slow breathing over the first 72 hours, as well as the hospital length of stay and occurrence of lung infection within 30 days.

Details
Condition Local Anesthetics, Local anesthesia, Fracture, Trauma, CHEST INJURY, Fracture of rib, Pain, Acute Pain Service, Patient-Controlled Analgesia, Levobupivacaine, rib fracture, local anaesthetics, ache, rib fractures, local anesthetic, local anaesthetic, chest injuries
Treatment patient controlled analgesia, Serratus plane block
Clinical Study IdentifierNCT03919916
SponsorChelsea and Westminster NHS Foundation Trust
Last Modified on12 June 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

years of age or older
Isolated chest trauma
Two or more unilateral rib fractures

Exclusion Criteria

One unilateral rib fracture
Bilateral rib fractures
Flail chest
Clavicular fractures
Polytrauma
Sternal fracture or injury
Thoracic spine injury
GCS less than 15
Acute or chronic confusional state
Delirium or psychiatric illness
Chronic lung disease necessitating home nebulisers and/or oxygen
Coagulopathy, defined as a platelet count less than 100 x 109/l , PT >15 or APTT >38
End stage liver disease
Severe congestive cardiac failure
Significant renal failure, defined as a creatinine >150mol/l
Local infection at potential site of SBP insertion
Pregnancy or breastfeeding
History of chronic pain or opioid dependence
Current chronic analgesic therapy, not to include paracetamol, NSAIDs and/or codeine
Requirement for tracheal intubation and mechanical ventilation
Allergy to local anaesthetics and/or opioids
Inability to control and self-administer opioids with PCA due to confusion, learning difficulties or poor manual dexterity
Unable to speak and/or understand English
Patients known to clinicians to be COVID-19 positive as determined by PCR or for whom there is a clinical suspicion that they might be COVID-19 positive will be excluded from the trial
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