Ultrasound- Guided Continuous Retro Laminar Block Versus Continuous Erector Spinae Plane Block in Multiple Rib Fractures

Tanta University

Status: Completed

Conditions: Spirometry; Retrolaminar Block; Erector Spinae Plane Block; Multiple Rib Fractures; Pain

Treatments: Drug: Retrolaminar block group; Drug: Erector spinae plane block group.

Study type: Interventional

Funder types: Other

Identifiers

NCT06088836

36264MD35/2/23

Details and patient eligibility

About

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.

Full 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.

Enrollment: 60 patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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60 participants in 2 patient groups

Group I (Retrolaminar block group)

Experimental group

Description:

Patients received ultrasound guided Retrolaminar block bolus dose of 20 ml 0.25% bupivacaine then continuous infusion at a rate of 0.1 mL/kg/hr. for 4 days

Treatment:

Drug: Retrolaminar block group

Group II (Erector spinae plane block group)

Experimental group

Description:

Patients received ultrasound guided Erector spinae plane block bolus dose of 20 ml 0.25% bupivacaine then continuous infusion at a rate of 0.1 mL/kg/hr. for 4 days

Treatment:

Drug: Erector spinae plane block group.