Trauma Clinical Trial
Official title:
Protocol for a Single Center Randomized Controlled Trial of Liposomal Bupivacaine Intercostal Nerve Blockade Versus Continuous Thoracic Epidural for Regional Analgesia in Patients With Multiple Rib Fractures
Management of traumatic rib fractures continues to be a challenge for trauma surgeons. Currently, many analgesic options are available to patients suffering from rib fractures. Formulations currently used for conventional intercostal nerve blocks (CINB) are relatively safe, do not require additional equipment or specialized anesthesia personnel, do not require catheter repositioning, and provide improved analgesia immediately over the aforementioned systemic therapies. A goal of these authors to introduce an additional safe option for extended local analgesia in the setting of multiple rib fractures given the inconclusive evidence supporting or refuting the current standard of care
The objective of this study is to quantify and draw inferences on the efficacy of a multiple
level liposomal bupivacaine intercostal nerve blockade (LBINB) in patients with multiple
traumatic rib fractures.
The primary objective is to assess the quality and duration of analgesia based on numeric
grading pain scale, improvement in pulmonary function parameters, reduction pulmonary
complications, and duration of hospitalization in patients receiving LBINBs relative to those
receiving the current standard of care, CEA, in patients recovering from multiple traumatic
rib fractures.
The secondary objective of this study is to assess cost and rate of complications associated
with LBINB relative to CEA.
This is a two arm, randomized trial. Patients suffering multiple traumatic rib fractures will
be offered CEA or LBINB. As the current standard of care, CEA will serve as the control, and
outcomes measured in patients receiving LBINB will be statistically evaluated relative to the
CEA control group.
All patients will receive standardized NSAID and opioid analgesia protocol for break through
pain, as well as standardized routines for pulmonary hygiene and physiotherapy.
Indications for CEA and LBINB in this study include patients suffering from traumatic
thoracic injury with greater than or equal to 3 fractured ribs
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