The Erector Spinae Plane Block and Its Effect on Respiratory Status and Pain Management in Rib Fracture Patients
| Status: | Not yet recruiting |
|---|---|
| Conditions: | Orthopedic |
| Therapuetic Areas: | Orthopedics / Podiatry |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 1/17/2019 |
| Start Date: | April 1, 2019 |
| End Date: | July 1, 2020 |
| Contact: | John Butterworth, MD |
| Email: | john.butterworth@vcuhealth.org |
| Phone: | (804) 828-9160 |
The purpose of this research study is to identify the benefits of a type of nerve block,
called an erector spinae plane block (ESP), in the treatment of patients with multiple rib
fractures and uncontrolled pain despite receiving current institutional standards of care.
called an erector spinae plane block (ESP), in the treatment of patients with multiple rib
fractures and uncontrolled pain despite receiving current institutional standards of care.
Rib fractures are one of the most common injuries secondary to blunt chest trauma, and carry
significant risk in terms of patient morbidity and mortality. Pulmonary complications
resulting from these injuries include severe atelectasis with hypoxemia, pneumonia, pleural
effusions, respiratory distress syndrome, need for mechanical ventilation and ICU admission,
and prolonged hospital stay. Many institutions have tried to develop protocols to risk
stratify and appropriately treat these patients, with the goal of predicting those with
higher likelihood of pulmonary complications in order to minimize additional morbidity.
Studies have demonstrated critical spirometry values which correlate to worse patient
outcomes; specifically, vital capacity less than 50% predicted, or less than 2L.
Subsequently, there have been numerous attempts to identify the best treatment interventions
for these high risk patients. In addition to multi-modal pain management, the most commonly
used procedures include thoracic epidurals, continuous or single shot paravertebral blocks,
and intercostal blocks. However, all of the above interventions carry significant risk, and
the frequent use lovenox thromboprophylaxis drastically limit their use. Recently, a novel
peripheral nerve block technique has been developed, an erector spinae plane block (ESP),
which may provide similar or greater efficacy to the above, with significantly less risk to
the patient.
significant risk in terms of patient morbidity and mortality. Pulmonary complications
resulting from these injuries include severe atelectasis with hypoxemia, pneumonia, pleural
effusions, respiratory distress syndrome, need for mechanical ventilation and ICU admission,
and prolonged hospital stay. Many institutions have tried to develop protocols to risk
stratify and appropriately treat these patients, with the goal of predicting those with
higher likelihood of pulmonary complications in order to minimize additional morbidity.
Studies have demonstrated critical spirometry values which correlate to worse patient
outcomes; specifically, vital capacity less than 50% predicted, or less than 2L.
Subsequently, there have been numerous attempts to identify the best treatment interventions
for these high risk patients. In addition to multi-modal pain management, the most commonly
used procedures include thoracic epidurals, continuous or single shot paravertebral blocks,
and intercostal blocks. However, all of the above interventions carry significant risk, and
the frequent use lovenox thromboprophylaxis drastically limit their use. Recently, a novel
peripheral nerve block technique has been developed, an erector spinae plane block (ESP),
which may provide similar or greater efficacy to the above, with significantly less risk to
the patient.
Inclusion Criteria:
- Blunt chest trauma
- Sustaining at least 3 unliateral rib fractures
- Resultant vital capacity less than 30% predicted
- Pain score reaches threshold despite using the current institutional standard of care
for pain control
Exclusion Criteria:
- Patients whose weight less than 60kg.
- Patients with bilateral rib fractures.
- Patients that are intubated and mechanically ventilated.
- Pregnant Individuals.
- Any individual with a documented allergy to ropivacaine.
- Patients with limited English proficiency (LEP)
- Patients whose body habitus prevents the practitioner's ability to adequately perform
the procedure.
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