A Retrospective Review of Rib Fracture Pain Management at a London Major Trauma Centre

NCT04863807 | Completed Results DMC

• 2 other identifiers: 19SM5668276933
• Study Type: observational
• Target: 389
• Locations: 1 country
• Sites: 1

Brief Summary

Thoracic epidural analgesia (TEA) is widely considered to be the current gold standard treatment for rib fracture pain and is used in the Imperial invasive treatment pathway for rib fractures. However, TEA are often contraindicated due to other injuries or the use of anticoagulant medications, which also contraindicates other invasive nerve block techniques e.g. paravertebral catheters. A number of case reports have reported the safe use of alternative techniques such as Serratus Anterior Blocks (SAPB) and Erector Spinae Blocks (ESPB) and the anaesthesia community has taken them up widely based on this relatively limited evidence. In view of this, Womack et al recently published a large retrospective review examining the safety and efficacy of ultrasound guided paravertebral catheter analgesia techniques in rib fracture management along with small numbers of ESPBs. However, this data did not report the analgesic efficacy, patient reported pain relief or respiratory complications.The goal is to advance this body of evidence by reviewing our larger data set concerning the use of TEA and alternative regional techniques such as ESPB and SAPB. This comprehensive review will benefit patients by documenting the efficacy and safety of these techniques for clinicians managing rib fracture patients.

Conditions

Rib Fractures; Pain, Acute

Keywords

epidural; erector spinae block; serratus anterior block

Outcome Measures

Primary Outcomes (1)

• The Proportion of Patients With a Reduction in Pain

  The investigators will review pain scores as recorded by clinical staff over 72 hours to assess pain relief efficacy, A verbal rating scale classifying pain as mild, moderate or severe is used at Imperial Data from the acute pain round records will also provide details regarding breathing comfort levels of the patient, coughing ability and deep inspiratory effort. These are recorded as yes/no answers and the team will assess the proportion of patients showing a reduction in pain scores.

  72 hours

Secondary Outcomes (6)

• Opioid Consumption (mg/24h)

  72 hours

• Nausea and Vomiting

  72 hours post block

• Number of Patients With Respiratory Complication(s)'

  Length of stay up to 8 weeks

• Intensive Care Admission

  Length of stay up to 8 weeks in days

• Intensive Care Admission

  Length of stay up to 8 weeks in days

Study Arms (3)

Thoracic epidural for rib fracture management

Patients aged \> 18 years of age presenting with traumatic rib fractures in a major trauma centre over the past 5 years that meet the criteria for the Imperial College Healthcare National Health Service (NHS) Trust 'Invasive rib fracture management pathway'

Procedure: Regional Anaesthesia

Erector Spinae block for rib fracture management

Patients aged \> 18 years of age presenting with traumatic rib fractures in a major trauma centre over the past 5 years that meet the criteria for the Imperial College Healthcare NHS Trust 'Invasive rib fracture management pathway'

Procedure: Regional Anaesthesia

Serratus Anterior block for rib fracture management

Patients aged \> 18 years of age presenting with traumatic rib fractures in a major trauma centre over the past 5 years that meet the criteria for the Imperial College Healthcare NHS Trust 'Invasive rib fracture management pathway'

Procedure: Regional Anaesthesia

Interventions

Regional Anaesthesia PROCEDURE

Thoracic epidural/Erector Spinae block/Serratus Anterior block

Erector Spinae block for rib fracture management; Serratus Anterior block for rib fracture management; Thoracic epidural for rib fracture management

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

* Patients aged \> 18 years of age presenting with traumatic rib fractures in a major trauma centre over the past 5 years * Meet the criteria for the Imperial College Healthcare NHS Trust 'Invasive rib fracture management pathway' (see Appendix A)

You may qualify if:

• Patients aged \> 18 years of age presenting with traumatic rib fractures in a major trauma centre over the past 5 years
• Meet the criteria for the Imperial College Healthcare NHS Trust 'Invasive rib fracture management pathway'

You may not qualify if:

• Under 18 years old
• Prisoners
• Pregnant
• Private patients
• Meet the criteria for the Imperial College Healthcare NHS Trust 'Non-invasive rib fracture management pathway'

Sponsors & Collaborators

• Imperial College Healthcare NHS Trust: lead

Study Sites (1)

Imperiial Collge Healthcare NHS Trust

London, W2 1NY, United Kingdom

Location

Related Publications (7)

• 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.

  PMID: 16385313 BACKGROUND

• Jones KM, Reed RL 2nd, Luchette FA. The ribs or not the ribs: which influences mortality? Am J Surg. 2011 Nov;202(5):598-604. doi: 10.1016/j.amjsurg.2010.09.029. Epub 2011 Aug 26.

  PMID: 21872207 BACKGROUND

• 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.

  PMID: 30740657 BACKGROUND

• Ahn Y, Gorlinger K, Alam HB, Eikermann M. Pain-associated respiratory failure in chest trauma. Anesthesiology. 2013 Mar;118(3):701-8. doi: 10.1097/ALN.0b013e318283996b. No abstract available.

  PMID: 23403516 RESULT

• Barnea Y, Kashtan H, Skornick Y, Werbin N. Isolated rib fractures in elderly patients: mortality and morbidity. Can J Surg. 2002 Feb;45(1):43-6.

  PMID: 11837920 RESULT

• Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol. Trauma Surg Acute Care Open. 2017 Jan 5;2(1):e000064. doi: 10.1136/tsaco-2016-000064. eCollection 2017.

  PMID: 29766081 RESULT

• Womack J, Pearson JD, Walker IA, Stephens NM, Goodman BA. Safety, complications and clinical outcome after ultrasound-guided paravertebral catheter insertion for rib fracture analgesia: a single-centre retrospective observational study. Anaesthesia. 2019 May;74(5):594-601. doi: 10.1111/anae.14580. Epub 2019 Jan 27.

  PMID: 30687939 RESULT

MeSH Terms

Conditions

Rib Fractures; Acute Pain

Interventions

Anesthesia, Conduction

Condition Hierarchy (Ancestors)

Fractures, Bone; Wounds and Injuries; Thoracic Injuries; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Anesthesia; Anesthesia and Analgesia

Results Point of Contact

• Title: Dr Alex Wickham
• Organization: Imperial College Healthcare NHS Trust

alex.wickham@nhs.net

+4420233121248

Study Officials

• Boyne Bellew

  Imperial College Healthcare NHS Trust

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 22, 2021
• First Posted: April 28, 2021
• Study Start: November 11, 2020
• Primary Completion: March 4, 2021
• Study Completion: March 30, 2021
• Last Updated: November 15, 2024
• Results First Posted: November 15, 2024

Record last verified: 2024-11

Data Sharing

• IPD Sharing: Will not share

Locations

GB (1)