Erector Spinae Plane (ESP) Versus Paravertebral Nerve (PVB) Blockade for Acute Unilateral Rib Fracture Pain
Rib Fractures, Pain, Acute, Thoracic Injuries
About this trial
This is an interventional treatment trial for Rib Fractures
Eligibility Criteria
Inclusion Criteria:
- Age between 18-85 years
- no contraindications to the placement of a paravertebral catheter or erector spinae plane catheter
- American Society of Anesthesiologists physical status between I-IV
- no chronic opioid use
- patients who are not expected to be on therapeutic anticoagulants post-procedurally
- no clopidogrel in last 48 hours
- no known allergies to any of the drugs/agents used study protocol
- no personal or family history of malignant hyperthermia
- not pregnant
- not having an altered mental status (oriented to place, person, or time)
- no comorbid condition(s) that in the judgment of the anesthesiologist, would preclude the patient from any aspect of the study. Comorbid conditions include bleeding disorders, thrombocytopenia, localized infection, sepsis, possibly abnormalities of the thoracic spine or paravertebral anatomy neoplastic mass occupying the paravertebral space, empyema, allergy to local anesthestic drug, increased intracranial pressure, severe uncorrected hypovolemia, fixed cardiac output states.
Exclusion Criteria:
- Age younger than 18 years or older than 85 years
- any contraindication to the placement of a paravertebral or erector spinae catheters
- American Society of Anesthesiologists physical status V or greater
- chronic opioid use
- coagulation abnormalities or patients who are expected to be on therapeutic anticoagulants postprocedurally
- clopidogrel use within 48 hours
- allergy to any of the drugs/agents used study protocol
- personal or family history of malignant hyperthermia
- pregnancy
- having an altered mental status (not oriented to place, person, or time), (11) any comorbid condition that in the judgment of the anesthesiologist would preclude the patient from any aspect of the study
- patient refusal. Comorbid conditions include bleeding disorders, thrombocytopenia, localized infection, sepsis, possibly abnormalities of the thoracic spine or paravertebral anatomy neoplastic mass occupying the paravertebral space, empyema, allergy to local anesthetic drug, increased intracranial pressure, severe uncorrected hypovolemia, fixed cardiac output states.
Sites / Locations
- University of Pittsburgh Medical Center - Presbyterian Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Erector Spinae Plane Block
Paravertebral Nerve Block
The patients randomized to the Erector Spinae Plane Block arm will receive this nerve block at the level corresponding to the rib fractures. Ropivicaine 0.5% 25 mL will be used during the procedure for initiation of pain control. Bupivicaine 0.0625% will be used for continuous infusion of local anesthetic. It will be titrated to effect, at maximum 12 mL/hr. Bupivicaine 0.0625% 3mL will be given every hour as a bolus additionally.
The patients randomized to the Paravertebral Nerve Block arm will receive this nerve block at the level corresponding to the rib fractures. Ropivicaine 0.5% 25 mL will be used during the procedure for initiation of pain control. Bupivicaine 0.0625% will be used for continuous infusion of local anesthetic. It will be titrated to effect, at maximum 12 mL/hr. Bupivicaine 0.0625% 3mL will be given every hour as a bolus additionally.