Role of Nerve Block in Management of Multiple Rib Fractures

NCT06958549 | Not Yet Recruiting Phase 4

• 1 other identifier: RIBFRACTURE
• Study Type: interventional
• Target: 74
• Locations: 0 countries
• Sites: N/A

Brief Summary

• Epidemiology \& Impact Thoracic trauma is a common and serious injury worldwide-especially in developing countries-and carries high rates of morbidity and mortality. Complications arise primarily from hypoventilation, which leads to atelectasis, pneumonia, and respiratory failure.
• Key to Reducing Complications: Pain Control Effective analgesia is the cornerstone of preventing respiratory complications. Inadequate pain relief causes patients to splint and hypoventilate, setting the stage for pulmonary collapse and infection.
• Conservative Management
• Analgesics: Systemic pharmacological pain relief remains the mainstay.
• Supportive Measures: Rest, application of ice, and encouragement of deep breathing exercises.
• Incentive Spirometry: Promoted in all patients to maintain lung expansion and ward off atelectasis.
• Regional Anesthesia Techniques To further improve comfort and respiratory mechanics, ultrasound-guided nerve blocks are employed according to fracture location:
• Serratus Anterior Plane Block for anterolateral rib fractures
• Thoracic Paravertebral Block for posterior rib fractures
• Surgical Intervention Reserved for complex cases-such as flail chest or fractures with risk of organ injury-where stabilization or repair may be necessary.
• Identified Gap Despite these options, thoracic surgeons currently lack a standardized, procedure-specific pain management protocol beyond systemic analgesics, highlighting a need for consensus guidelines that integrate pharmacological and regional techniques.

Conditions

Multiple Rib Fractures

Outcome Measures

Primary Outcomes (1)

• Improvement in patients pain score (neumerical score)

  day 0, day 1 and day 3

Secondary Outcomes (3)

• improving intercostal tube duration in days

  day 2, day 4 and day 6

• improving total hospital stay in days

  day 2, day 4 and day 6

• improving patient satisfaction (questionnaire)

  day 0, day 2, day 4 and day 6

Study Arms (2)

nerve block

ACTIVE COMPARATOR

Procedure: Nerve block with Lidocain

pharmacological analgesics

ACTIVE COMPARATOR

Drug: pharmacological analgesics

Interventions

Nerve block with Lidocain PROCEDURE

Injection of Lidocaine (7mg/kg) with Epinephrine 1:100000 under Ultrasonographical guidance

nerve block

pharmacological analgesics DRUG

Oral Paracetamol (500mg/6hr), IV Ketolac (15mg/6hr) and IV perfelgan (1gm/6hr)

pharmacological analgesics

Eligibility Criteria

• Age: 18 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• All trauma adult patient (18-70 years) with multiple fracture ribs

You may not qualify if:

• Patient with multiple fracture rib with anterior flail segment
• Significant head trauma

Sponsors & Collaborators

• Assiut University: lead

Related Publications (4)

• Kring RM, Mackenzie DC, Wilson CN, Rappold JF, Strout TD, Croft PE. Ultrasound-Guided Serratus Anterior Plane Block (SAPB) Improves Pain Control in Patients With Rib Fractures. J Ultrasound Med. 2022 Nov;41(11):2695-2701. doi: 10.1002/jum.15953. Epub 2022 Feb 2.

  PMID: 35106815 BACKGROUND

• Yayik AM, Aydin ME, Tekin E, Ulas AB, Ahiskalioglu A. An alternative plane block for multiple rib fractures: Rhomboid Intercostal and Sub-Serratus block (RISS). Am J Emerg Med. 2019 Dec;37(12):2263.e5-2263.e7. doi: 10.1016/j.ajem.2019.158429. Epub 2019 Sep 6.

  PMID: 31526541 BACKGROUND

• Hwang EG, Lee Y. Effectiveness of intercostal nerve block for management of pain in rib fracture patients. J Exerc Rehabil. 2014 Aug 31;10(4):241-4. doi: 10.12965/jer.140137. eCollection 2014 Aug.

  PMID: 25210700 BACKGROUND

• Easter A. Management of patients with multiple rib fractures. Am J Crit Care. 2001 Sep;10(5):320-7; quiz 328-9.

  PMID: 11548565 BACKGROUND

MeSH Terms

Interventions

Nerve Block

Intervention Hierarchy (Ancestors)

Anesthesia, Conduction; Anesthesia; Anesthesia and Analgesia; Denervation; Neurosurgical Procedures; Surgical Procedures, Operative

Central Study Contacts

Mostafa A Kotb

CONTACT

+201091703324; Moustafa.16266040@med.aun.edu.eg

Ahmed M Nabil

CONTACT

+201005016071; ahmednabil@aun.adu.eg

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: April 16, 2025
• First Posted: May 6, 2025
• Study Start: December 1, 2025
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): April 1, 2027
• Last Updated: May 6, 2025

Record last verified: 2025-04