search
Back to results

Non-Inferiority Study of Erector Spinae Plane Block Compared to Thoracic Epidural in Pain Management of Rib Fractures (SUETHE-Ribs)

Primary Purpose

Rib Fractures

Status
Not yet recruiting
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
ESPB
TEA
Sponsored by
Indiana University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Rib Fractures

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • 18 years or older
  • Radiological evidence of 3 or more rib fractures
  • Within 48 hours of admission to hospital with rib fractures
  • Can actively participate by answering questions during TEA or ESPB placement
  • Moderate-severe (4-10 out of 10) pain at the time of enrollment

Exclusion Criteria:

  • Greater than 48 hrs since admission to the hospital with rib fractures
  • Patient refusal
  • Prisoner
  • Infection at the site of TEA or ESPB insertion
  • Allergy to local anesthetics
  • Depth from skin to catheter placement target 6 or more centimeters
  • Greater than 7 consecutive ribs involved on each side
  • Other regional or epidural block already received
  • Unable to follow commands/altered mental status
  • Dementia
  • Sepsis (temperature > 38 degrees Celsius & positive blood cultures)
  • Elevated intracranial pressure (ICP > 12 mm Hg)
  • Coagulopathy (INR > 1.4) or recent therapeutic anticoagulant use (varies with which medication the patient is on)
  • Preexisting central nervous system disorders, such as multiple sclerosis
  • Thrombocytopenia (Platelets <70,000)
  • Spine fracture or previous back surgery
  • Preload dependent states (aortic stenosis, hypertrophic obstructive cardiomyopathy)
  • Aortic transection
  • Hemodynamic instability (patients with MAPs <60 and/or patients requiring pressor support)
  • Tattoo at sight of catheter placement

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Active Comparator

    Active Comparator

    Arm Label

    ESPB Group

    TEA Group

    Arm Description

    20ml Ropivacaine is injected near the nerves in the back and then continued using an infusion pump.

    5ml Bupivacaine is injected into the space around the spinal cord and then continued using an infusion pump.

    Outcomes

    Primary Outcome Measures

    MRF pain at rest and with cough before and after TEA or ESPB placement using the pain visual analog scale (VAS) for pain in the thorax/ribs.
    Participants will be asked about their rib pain specifically during this assessment along with the maximum pain experienced and its location. VAS is used to measure pain on a scale of 1-10, with 1 being the least and 10 being the most amount of pain.
    MRF pain at rest and with cough before and after TEA or ESPB placement using the pain visual analog scale (VAS) for pain in the thorax/ribs.
    Participants will be asked about their rib pain specifically during this assessment along with the maximum pain experienced and its location. VAS is used to measure pain on a scale of 1-10, with 1 being the least and 10 being the most amount of pain.

    Secondary Outcome Measures

    Determine total systemic opioid and non-opioid medication use in patients with ESPB and TEA by reviewing patient EMR.
    Normalize medication use by subtracting baseline opioid and non-opioid medication use for amount received while hospitalized and compare injury severity prior to analysis.

    Full Information

    First Posted
    September 3, 2021
    Last Updated
    July 12, 2023
    Sponsor
    Indiana University
    search

    1. Study Identification

    Unique Protocol Identification Number
    NCT05069961
    Brief Title
    Non-Inferiority Study of Erector Spinae Plane Block Compared to Thoracic Epidural in Pain Management of Rib Fractures
    Acronym
    SUETHE-Ribs
    Official Title
    Non- Inferiority Study of Erector Spinae Plane Block Compared to Thoracic Epidural Analgesia in Multimodal Pain Management of Multiple Rib Fractures
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    September 30, 2023 (Anticipated)
    Primary Completion Date
    September 2026 (Anticipated)
    Study Completion Date
    September 2026 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Indiana University

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Product Manufactured in and Exported from the U.S.
    No
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    The purpose of this study is to compare 2 pain control treatments for people with 3 or more rib fractures.
    Detailed Description
    2.1 Primary Objective Compare efficacy of ESPB to TEA for MRF analgesia. 2.2 Secondary Objective Compare systemic opioid and non-opioid medication use in patients with ESPB and TEA. 2.3 Tertiary/Exploratory/Correlative Objectives Determine improvement in respiratory function in ESPB versus TEA before and after analgesia placement. Compare complications that occur in patients who receive ESPB versus TEA. Compare dermatome levels relative to catheter placement that achieve analgesia for TEA and ESPB. Compare differences in deep vein thrombosis (DVT) prophylaxis and incidence between ESPB and TEA. Differences in length of stay (LOS) for TEA versus ESPB. Differences in risk of delirium between TEA and ESPB. Differences in oxygen and ventilatory support between TEA and ESPB. Patient satisfaction of pain management.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Rib Fractures

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Not Applicable
    Interventional Study Model
    Parallel Assignment
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    124 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    ESPB Group
    Arm Type
    Active Comparator
    Arm Description
    20ml Ropivacaine is injected near the nerves in the back and then continued using an infusion pump.
    Arm Title
    TEA Group
    Arm Type
    Active Comparator
    Arm Description
    5ml Bupivacaine is injected into the space around the spinal cord and then continued using an infusion pump.
    Intervention Type
    Procedure
    Intervention Name(s)
    ESPB
    Intervention Description
    Ropivacaine is injected near the nerves in the back
    Intervention Type
    Procedure
    Intervention Name(s)
    TEA
    Intervention Description
    Bupivacaine is injected into the space around the spinal cord.
    Primary Outcome Measure Information:
    Title
    MRF pain at rest and with cough before and after TEA or ESPB placement using the pain visual analog scale (VAS) for pain in the thorax/ribs.
    Description
    Participants will be asked about their rib pain specifically during this assessment along with the maximum pain experienced and its location. VAS is used to measure pain on a scale of 1-10, with 1 being the least and 10 being the most amount of pain.
    Time Frame
    24 hours after catheter placement
    Title
    MRF pain at rest and with cough before and after TEA or ESPB placement using the pain visual analog scale (VAS) for pain in the thorax/ribs.
    Description
    Participants will be asked about their rib pain specifically during this assessment along with the maximum pain experienced and its location. VAS is used to measure pain on a scale of 1-10, with 1 being the least and 10 being the most amount of pain.
    Time Frame
    72 hours after catheter placement
    Secondary Outcome Measure Information:
    Title
    Determine total systemic opioid and non-opioid medication use in patients with ESPB and TEA by reviewing patient EMR.
    Description
    Normalize medication use by subtracting baseline opioid and non-opioid medication use for amount received while hospitalized and compare injury severity prior to analysis.
    Time Frame
    After patient discharge up to 7 days
    Other Pre-specified Outcome Measures:
    Title
    Incentive spirometry
    Description
    Maximum incentive spirometry volume (in mL) will be gathered.
    Time Frame
    Baseline, pre-intervention and immediately following intervention.
    Title
    Rate of adverse events/complications related to ESPB and TEA
    Description
    Track adverse events/complications related to ESPB and TEA such as pneumothorax, pneumonia, infection at catheter site, DVT, pulmonary embolism, urinary retention, hypotension, spinal cord injury, systemic anesthetic toxicity, epidural hematoma, and loss of motor function.
    Time Frame
    Duration of hospital stay up to 7 days.
    Title
    Dermatome levels with analgesia
    Description
    Determine dermatome levels with analgesia using via cold sensory.
    Time Frame
    Immediately following infusion.
    Title
    Dermatome levels with analgesia
    Description
    Determine dermatome levels with analgesia using via cold sensory.
    Time Frame
    30 minutes after infusion.
    Title
    Dermatome levels with analgesia
    Description
    Determine dermatome levels with analgesia using via cold sensory.
    Time Frame
    Once a day in the morning, after intervention. They will be checked until the catheter is removed, which will be 7 days at the longest.
    Title
    Risk assessment profile (RAP) score
    Description
    Standard trauma protocol includes all trauma inpatients getting a risk assessment profile (RAP) score. A RAP score <5 needs no additional monitoring. A RAP score >/= 5 gets anti-Xa monitoring (4 hrs after 3rd consecutive dose with goal parameters 0.2-0.4). A RAP score >/= 11 gets Anti-Xa monitoring plus weekly lower extremity dopplers ultrasound. This data will be in the EMR as it is standard protocol currently.
    Time Frame
    After patient discharge up to 7 days
    Title
    The time spent in the intensive care unit (ICU)
    Description
    Total time spent in ICU
    Time Frame
    Duration of hospital stay, up to 7 days.
    Title
    Total length of hospital stay
    Description
    Amount of time each subject spends in the hospital before discharge.
    Time Frame
    Up to 7 days.
    Title
    Confusion assessment method (CAM-ICU)
    Description
    Scores will be charted daily and reviewed in the EMR to determine if differences in delirium are present for patients receiving TEA versus ESPB
    Time Frame
    Daily during hospital stay up to 7 days.
    Title
    Richmond Agitation-Sedation Scale (RASS)
    Description
    Scores will be charted daily and reviewed in the EMR to determine if differences in sedation are present for patients receiving TEA versus ESPB. The scale ratings range from +4 (combative/violent/immediate danger) to -5 (unarousable).
    Time Frame
    Daily during hospital stay up to 7 days.
    Title
    FiO2 and time on a ventilator
    Description
    Will be compared between ESPB and TEA. These values are monitored in the EMR and will be reviewed from the EMR.
    Time Frame
    Duration of hospital stay, up to 7 days.
    Title
    Participant satisfaction assessed on a 5 pt. scale
    Description
    Assess participant satisfaction of the ESPB and TEA for MRF pain management on a 5 pt scale with 0 being "unsatisfied" and 4 being "very satisfied".
    Time Frame
    Daily during hospital stay, up to 7 days.
    Title
    Pain scores
    Description
    Pain scores are tracked in the EMR at multiple times during the day. These will be utilized to compare morning and evening charted pain scores to the ones obtained during the morning data collection
    Time Frame
    Duration of hospital stay, up to 7 days.

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: 18 years or older Radiological evidence of 3 or more rib fractures Within 48 hours of admission to hospital with rib fractures Can actively participate by answering questions during TEA or ESPB placement Moderate-severe (4-10 out of 10) pain at the time of enrollment Exclusion Criteria: Greater than 48 hrs since admission to the hospital with rib fractures Patient refusal Prisoner Infection at the site of TEA or ESPB insertion Allergy to local anesthetics Depth from skin to catheter placement target 6 or more centimeters Greater than 7 consecutive ribs involved on each side Other regional or epidural block already received Unable to follow commands/altered mental status Dementia Sepsis (temperature > 38 degrees Celsius & positive blood cultures) Elevated intracranial pressure (ICP > 12 mm Hg) Coagulopathy (INR > 1.4) or recent therapeutic anticoagulant use (varies with which medication the patient is on) Preexisting central nervous system disorders, such as multiple sclerosis Thrombocytopenia (Platelets <70,000) Spine fracture or previous back surgery Preload dependent states (aortic stenosis, hypertrophic obstructive cardiomyopathy) Aortic transection Hemodynamic instability (patients with MAPs <60 and/or patients requiring pressor support) Tattoo at sight of catheter placement
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Ross Mirman, MD
    Phone
    (317) 274-0275
    Email
    rmirman@iu.edu
    First Name & Middle Initial & Last Name or Official Title & Degree
    Lyla Farlow, LPN
    Phone
    317-948-9804
    Email
    lychrist@iupui.edu
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Ross Mirman, MD
    Organizational Affiliation
    Indiana University School of Medicine
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No
    Citations:
    Citation
    Xu J, Murphy SL, Kochanek KD, Arias E: Mortality in the United States, 2018. In. Edited by Services USDoHaH. Online: National Center for Health Statistics; 2020.
    Results Reference
    background
    PubMed Identifier
    7996614
    Citation
    Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994 Dec;37(6):975-9. doi: 10.1097/00005373-199412000-00018.
    Results Reference
    background
    PubMed Identifier
    16269301
    Citation
    Flagel BT, Luchette FA, Reed RL, Esposito TJ, Davis KA, Santaniello JM, Gamelli RL. Half-a-dozen ribs: the breakpoint for mortality. Surgery. 2005 Oct;138(4):717-23; discussion 723-5. doi: 10.1016/j.surg.2005.07.022.
    Results Reference
    background
    PubMed Identifier
    12634526
    Citation
    Bergeron E, Lavoie A, Clas D, Moore L, Ratte S, Tetreault S, Lemaire J, Martin M. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma. 2003 Mar;54(3):478-85. doi: 10.1097/01.TA.0000037095.83469.4C.
    Results Reference
    background
    PubMed Identifier
    3606246
    Citation
    Shorr RM, Crittenden M, Indeck M, Hartunian SL, Rodriguez A. Blunt thoracic trauma. Analysis of 515 patients. Ann Surg. 1987 Aug;206(2):200-5. doi: 10.1097/00000658-198708000-00013.
    Results Reference
    background
    PubMed Identifier
    10235527
    Citation
    Moon MR, Luchette FA, Gibson SW, Crews J, Sudarshan G, Hurst JM, Davis K Jr, Johannigman JA, Frame SB, Fischer JE. Prospective, randomized comparison of epidural versus parenteral opioid analgesia in thoracic trauma. Ann Surg. 1999 May;229(5):684-91; discussion 691-2. doi: 10.1097/00000658-199905000-00011.
    Results Reference
    background
    PubMed Identifier
    12059888
    Citation
    Govindarajan R, Bakalova T, Michael R, Abadir AR. Epidural buprenorphine in management of pain in multiple rib fractures. Acta Anaesthesiol Scand. 2002 Jul;46(6):660-5. doi: 10.1034/j.1399-6576.2002.460605.x.
    Results Reference
    background
    PubMed Identifier
    1902264
    Citation
    Mackersie RC, Karagianes TG, Hoyt DB, Davis JW. Prospective evaluation of epidural and intravenous administration of fentanyl for pain control and restoration of ventilatory function following multiple rib fractures. J Trauma. 1991 Apr;31(4):443-9; discussion 449-51.
    Results Reference
    background
    PubMed Identifier
    9156291
    Citation
    Mayberry JC, Trunkey DD. The fractured rib in chest wall trauma. Chest Surg Clin N Am. 1997 May;7(2):239-61.
    Results Reference
    background
    PubMed Identifier
    12634549
    Citation
    Karmakar MK, Ho AM. Acute pain management of patients with multiple fractured ribs. J Trauma. 2003 Mar;54(3):615-25. doi: 10.1097/01.TA.0000053197.40145.62.
    Results Reference
    background
    PubMed Identifier
    2298017
    Citation
    Cicala RS, Voeller GR, Fox T, Fabian TC, Kudsk K, Mangiante EC. Epidural analgesia in thoracic trauma: effects of lumbar morphine and thoracic bupivacaine on pulmonary function. Crit Care Med. 1990 Feb;18(2):229-31.
    Results Reference
    background
    PubMed Identifier
    21716105
    Citation
    Ho AM, Karmakar MK, Critchley LA. Acute pain management of patients with multiple fractured ribs: a focus on regional techniques. Curr Opin Crit Care. 2011 Aug;17(4):323-7. doi: 10.1097/MCC.0b013e328348bf6f.
    Results Reference
    background
    PubMed Identifier
    7638994
    Citation
    Gabram SG, Schwartz RJ, Jacobs LM, Lawrence D, Murphy MA, Morrow JS, Hopkins JS, Knauft RF. Clinical management of blunt trauma patients with unilateral rib fractures: a randomized trial. World J Surg. 1995 May-Jun;19(3):388-93. doi: 10.1007/BF00299166.
    Results Reference
    background
    PubMed Identifier
    27550958
    Citation
    Jensen CD, Stark JT, Jacobson LL, Powers JM, Joseph MF, Kinsella-Shaw JM, Denegar CR. Improved Outcomes Associated with the Liberal Use of Thoracic Epidural Analgesia in Patients with Rib Fractures. Pain Med. 2017 Sep 1;18(9):1787-1794. doi: 10.1093/pm/pnw199.
    Results Reference
    background
    PubMed Identifier
    22673788
    Citation
    De Buck F, Devroe S, Missant C, Van de Velde M. Regional anesthesia outside the operating room: indications and techniques. Curr Opin Anaesthesiol. 2012 Aug;25(4):501-7. doi: 10.1097/ACO.0b013e3283556f58.
    Results Reference
    background
    PubMed Identifier
    15300210
    Citation
    Bulger EM, Edwards T, Klotz P, Jurkovich GJ. Epidural analgesia improves outcome after multiple rib fractures. Surgery. 2004 Aug;136(2):426-30. doi: 10.1016/j.surg.2004.05.019.
    Results Reference
    background
    PubMed Identifier
    27533913
    Citation
    Galvagno SM Jr, Smith CE, Varon AJ, Hasenboehler EA, Sultan S, Shaefer G, To KB, Fox AD, Alley DE, Ditillo M, Joseph BA, Robinson BR, Haut ER. Pain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society. J Trauma Acute Care Surg. 2016 Nov;81(5):936-951. doi: 10.1097/TA.0000000000001209.
    Results Reference
    background
    PubMed Identifier
    16385313
    Citation
    Simon BJ, Cushman J, Barraco R, Lane V, Luchette FA, Miglietta M, Roccaforte DJ, Spector R; EAST Practice Management Guidelines Work Group. Pain management guidelines for blunt thoracic trauma. J Trauma. 2005 Nov;59(5):1256-67. doi: 10.1097/01.ta.0000178063.77946.f5. No abstract available.
    Results Reference
    background
    PubMed Identifier
    8703169
    Citation
    Geerts WH, Jay RM, Code KI, Chen E, Szalai JP, Saibil EA, Hamilton PA. A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. N Engl J Med. 1996 Sep 5;335(10):701-7. doi: 10.1056/NEJM199609053351003.
    Results Reference
    background
    PubMed Identifier
    12131409
    Citation
    Rogers FB, Cipolle MD, Velmahos G, Rozycki G, Luchette FA. Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST practice management guidelines work group. J Trauma. 2002 Jul;53(1):142-64. doi: 10.1097/00005373-200207000-00032. No abstract available.
    Results Reference
    background
    PubMed Identifier
    28525509
    Citation
    Malekpour M, Hashmi A, Dove J, Torres D, Wild J. Analgesic Choice in Management of Rib Fractures: Paravertebral Block or Epidural Analgesia? Anesth Analg. 2017 Jun;124(6):1906-1911. doi: 10.1213/ANE.0000000000002113.
    Results Reference
    background
    PubMed Identifier
    19359920
    Citation
    Mohta M, Verma P, Saxena AK, Sethi AK, Tyagi A, Girotra G. Prospective, randomized comparison of continuous thoracic epidural and thoracic paravertebral infusion in patients with unilateral multiple fractured ribs--a pilot study. J Trauma. 2009 Apr;66(4):1096-101. doi: 10.1097/TA.0b013e318166d76d.
    Results Reference
    background
    PubMed Identifier
    14960978
    Citation
    Osinowo OA, Zahrani M, Softah A. Effect of intercostal nerve block with 0.5% bupivacaine on peak expiratory flow rate and arterial oxygen saturation in rib fractures. J Trauma. 2004 Feb;56(2):345-7. doi: 10.1097/01.TA.0000046257.70194.2D.
    Results Reference
    background
    PubMed Identifier
    8651535
    Citation
    Short K, Scheeres D, Mlakar J, Dean R. Evaluation of intrapleural analgesia in the management of blunt traumatic chest wall pain: a clinical trial. Am Surg. 1996 Jun;62(6):488-93.
    Results Reference
    background
    PubMed Identifier
    7573876
    Citation
    Lonnqvist PA, MacKenzie J, Soni AK, Conacher ID. Paravertebral blockade. Failure rate and complications. Anaesthesia. 1995 Sep;50(9):813-5. doi: 10.1111/j.1365-2044.1995.tb06148.x.
    Results Reference
    background
    PubMed Identifier
    7488477
    Citation
    Richardson J, Sabanathan S, Mearns AJ, Shah RD, Goulden C. A prospective, randomized comparison of interpleural and paravertebral analgesia in thoracic surgery. Br J Anaesth. 1995 Oct;75(4):405-8. doi: 10.1093/bja/75.4.405.
    Results Reference
    background
    PubMed Identifier
    11535906
    Citation
    Shanti CM, Carlin AM, Tyburski JG. Incidence of pneumothorax from intercostal nerve block for analgesia in rib fractures. J Trauma. 2001 Sep;51(3):536-9. doi: 10.1097/00005373-200109000-00019.
    Results Reference
    background
    PubMed Identifier
    25247916
    Citation
    Kunhabdulla NP, Agarwal A, Gaur A, Gautam SK, Gupta R, Agarwal A. Serratus anterior plane block for multiple rib fractures. Pain Physician. 2014 Sep-Oct;17(5):E651-3. No abstract available.
    Results Reference
    background
    PubMed Identifier
    27501016
    Citation
    Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016 Sep-Oct;41(5):621-7. doi: 10.1097/AAP.0000000000000451.
    Results Reference
    background
    PubMed Identifier
    30443066
    Citation
    Jain K, Jaiswal V, Puri A. Erector spinae plane block: Relatively new block on horizon with a wide spectrum of application - A case series. Indian J Anaesth. 2018 Oct;62(10):809-813. doi: 10.4103/ija.IJA_263_18.
    Results Reference
    background
    PubMed Identifier
    29416155
    Citation
    Adhikary SD, Pruett A, Forero M, Thiruvenkatarajan V. Erector spinae plane block as an alternative to epidural analgesia for post-operative analgesia following video-assisted thoracoscopic surgery: A case study and a literature review on the spread of local anaesthetic in the erector spinae plane. Indian J Anaesth. 2018 Jan;62(1):75-78. doi: 10.4103/ija.IJA_693_17.
    Results Reference
    background
    PubMed Identifier
    32517405
    Citation
    Barrios A, Camelo J, Gomez J, Forero M, Peng PWH, Visbal K, Cadavid A. Evaluation of Sensory Mapping of Erector Spinae Plane Block. Pain Physician. 2020 Jun;23(3):E289-E296.
    Results Reference
    background
    PubMed Identifier
    28188611
    Citation
    El-Boghdadly K, Pawa A. The erector spinae plane block: plane and simple. Anaesthesia. 2017 Apr;72(4):434-438. doi: 10.1111/anae.13830. Epub 2017 Feb 11. No abstract available.
    Results Reference
    background
    PubMed Identifier
    32517407
    Citation
    Shibata Y, Kampitak W, Tansatit T. The Novel Costotransverse Foramen Block Technique: Distribution Characteristics of Injectate Compared with Erector Spinae Plane Block. Pain Physician. 2020 Jun;23(3):E305-E314.
    Results Reference
    background
    PubMed Identifier
    29491521
    Citation
    Nandhakumar A, Nair A, Bharath VK, Kalingarayar S, Ramaswamy BP, Dhatchinamoorthi D. Erector spinae plane block may aid weaning from mechanical ventilation in patients with multiple rib fractures: Case report of two cases. Indian J Anaesth. 2018 Feb;62(2):139-141. doi: 10.4103/ija.IJA_599_17.
    Results Reference
    background
    PubMed Identifier
    30392675
    Citation
    Yayik AM, Ahiskalioglu A, Celik EC, Ay A, Ozenoglu A. [Continuous erector spinae plane block for postoperative analgesia of multiple rib fracture surgery: case report]. Braz J Anesthesiol. 2019 Jan-Feb;69(1):91-94. doi: 10.1016/j.bjan.2018.08.001. Epub 2018 Nov 2.
    Results Reference
    background
    PubMed Identifier
    32669087
    Citation
    Cao J, Gao X, Zhang X, Li J, Zhang J. Feasibility of laryngeal mask anesthesia combined with nerve block in adult patients undergoing internal fixation of rib fractures: a prospective observational study. BMC Anesthesiol. 2020 Jul 15;20(1):170. doi: 10.1186/s12871-020-01082-y.
    Results Reference
    background
    PubMed Identifier
    30740657
    Citation
    Adhikary SD, Liu WM, Fuller E, Cruz-Eng H, Chin KJ. The effect of erector spinae plane block on respiratory and analgesic outcomes in multiple rib fractures: a retrospective cohort study. Anaesthesia. 2019 May;74(5):585-593. doi: 10.1111/anae.14579. Epub 2019 Feb 10.
    Results Reference
    background
    PubMed Identifier
    32169144
    Citation
    Gursoy C, Kuscu Y, Demirbilek SG. Pain Management for Traumatic Rib Fractures with ESP Block in ICU. J Coll Physicians Surg Pak. 2020 Mar;30(3):318-320. doi: 10.29271/jcpsp.2020.03.318.
    Results Reference
    background
    PubMed Identifier
    32371819
    Citation
    Liu R, Clark L, Bautista A. Unilateral Bilevel Erector Spinae Plane Catheters for Flail Chest: A Case Report. A A Pract. 2020 May;14(7):e01211. doi: 10.1213/XAA.0000000000001211.
    Results Reference
    background
    Citation
    Epidural Anesthesia and Analgesia [https://www.nysora.com/regional-anesthesia-for-specific-surgical-procedures/abdomen/epidural-anesthesia-analgesia/]
    Results Reference
    background
    PubMed Identifier
    29420315
    Citation
    Bomberg H, Bayer I, Wagenpfeil S, Kessler P, Wulf H, Standl T, Gottschalk A, Doffert J, Hering W, Birnbaum J, Spies C, Kutter B, Winckelmann J, Liebl-Biereige S, Meissner W, Vicent O, Koch T, Sessler DI, Volk T, Raddatz A. Prolonged Catheter Use and Infection in Regional Anesthesia: A Retrospective Registry Analysis. Anesthesiology. 2018 Apr;128(4):764-773. doi: 10.1097/ALN.0000000000002105.
    Results Reference
    background

    Learn more about this trial

    Non-Inferiority Study of Erector Spinae Plane Block Compared to Thoracic Epidural in Pain Management of Rib Fractures

    We'll reach out to this number within 24 hrs