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Patients with ipsilateral multiple rib fractures will be randomized to receive either a single-shot ultrasound-guided serratus plane block, or a continuous serratus plane block within 24h from the chest trauma. Primary outcome is the difference in forced respiratory volume (FEV1) at 72h.
Patients admitted in emergency department with a chest trauma and ipsilateral multiple rib fractures, will be randomized as described above. All patients will receive the serratus block with a ropivacaine 0.37% solution 20 ml. Then, they will randomized to receive either a peripheral catheter placed above the 5th rib on the middle axillary line, or nothing. In all patients postoperative analgesia also include Paracetamol 1g IV each 6h and a patient controlled analgesia (PCA) of morphine set out as follow: bolus 1 mg, loch out 15 min, max 4 boluses each hour. In all patients an arterial blood sample for gas analysis and a FEV1 will be achieved before the block, after 1 hour and at 72h.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| continuous | Experimental | continuous local anesthetic infusion (ropivacaine 0.2%)on the serratus plane for at least 72h adds to a Single-shot serratus plane block with ropivacaine 0.37% solution 20 ml. |
|
| single-shot | Active Comparator | Single-shot serratus plane block with ropivacaine 0.37% solution 20 ml |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Serratus plane block | Procedure | Local anesthetic infusion though a peripheral nerve catheter placed on the 5th rib under the serratus plane |
|
| Measure | Description | Time Frame |
|---|---|---|
| Pulmonary change function | FEV 1 | day 0 and day 3 |
| Measure | Description | Time Frame |
|---|---|---|
| Numerical rating scale (NRS) of pain | Pain both at rest and on movement on a 0-10 scale where 0 is the best and 10 the worst | day 0, day 1, day 2, day 3, day 4 |
| Morphine | morphine requirement |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| AUSL IRCCS Reggio Emilia | Reggio Emilia | 42120 | Italy |
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| ID | Term |
|---|---|
| D013898 | Thoracic Injuries |
| D002637 | Chest Pain |
| ID | Term |
|---|---|
| D014947 | Wounds and Injuries |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
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| day 0, day 1, day 2, day 3, day 4 |
| hospital stay | time to fill the discharge criteria | day 1, day 2, day 3, day 4, day 5, day 6, day7 |
| D013568 |
| Pathological Conditions, Signs and Symptoms |