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The analgesic effect of continuous mid-point to pleura transverse process block compared to the analgesic effect of continuous thoracic intervertebral foramen block, in patients with multiple rib fractures.
The analgesic effect of continuous mid-point to pleura transverse process block will be compared to the analgesic effect of continuous thoracic intervertebral foramen block, in patients with multiple rib fractures, by using the numeric rating scale (NRS) for pain.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Thoracic intervertebral foramen block | Experimental | Under ultrasound guidance the continuous thoracic intervertebral foramen block, will be provided to achieve analgesia in polytraumatic patients with rib fractures. A set for continuous peripheral nerve block will be used. The infusion rate of analgesic solution (levobupivacaine 0.25% combined with dexamethasone 16 mg) will be titrated to patient perceived pain. |
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| Mid-point to pleura transverse process block | Active Comparator | Under ultrasound guidance the continuous mid-point to pleura transverse process block, will be provided to achieve analgesia in polytraumatic patients with rib fractures. A set for continuous peripheral nerve block will be used. The infusion rate of analgesic solution (levobupivacaine 0.25% combined with dexamethasone 16 mg) will be titrated to patient perceived pain. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Thoracic intervertebral foramen block | Procedure | Under ultrasound guidance the continuous thoracic intervertebral foramen block, will be provided to achieve analgesia in polytraumatic patients with rib fractures. A set for continuous peripheral nerve block will be used. The infusion rate of analgesic solution (levobupivacaine 0.25% combined with dexamethasone 16 mg) will be titrated to patient perceived pain. The block will be performed close, by considering the level of rib fractures. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain intensity | The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. "no pain") to '10' representing the other pain extreme (e.g. "pain as bad as you can imagine" or "worst pain imaginable" | First 72 hours from the block |
| Measure | Description | Time Frame |
|---|---|---|
| Diaphragmatic motion | The percentage of diaphragmatic thickening measured as thickness at end-inspiration-thickness at end-expiration divided by thickness at end-expiration | First 72 hours from the block |
| Arterial blood gas analysis |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Emiliano Petrucci, MD | San Salvatore Acadec Hospital of L'Aquila (Italy) | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Emiliano | L’Aquila | L'Aquila | 67100 | Italy |
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| ID | Term |
|---|---|
| D059787 | Acute Pain |
| D012253 | Rib Fractures |
| D009104 | Multiple Trauma |
| D000377 | Agnosia |
| ID | Term |
|---|---|
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| Mid-point to pleura transverse process block | Procedure | Under ultrasound guidance the continuous mid-point to pleura transverse process block, will be provided to achieve analgesia in polytraumatic patients with rib fractures. A set for continuous peripheral nerve block will be used. The infusion rate of analgesic solution (levobupivacaine 0.25% combined with dexamethasone 16 mg) will be titrated to patient perceived pain. The block will be performed close, by considering the level of rib fractures. |
|
Fraction of inspired oxygen to partial pressure of oxygen ratio
| First 72 hours from the block |
| Airflow rate | Patient airflow rate measured in mL/second, by using an incentive spirometer with three balls | First 72 hours from the block |
| Blood pressure | Invasive blood pressure (systolic and diastolic pressure in mmHg) | First 72 hours from the block |
| Sensory block | Response to the stimulus (yes or no), by using a piece of cotton, and ice in a finger of surgical glove on the patient's skin. | First 72 hours from the block |
| Request of analgesic drugs | Consumption of analgesic drugs (equivalent mg of morphine) | First 72 hours from the block |
| Anesthetic spread | Thoracic paravertebral space spread (yes or no), evaluated with ultrasonography | First 72 hours from the block |
| Complication | Number of pneumothorax, hemothorax, hematoma, pain, infection, and neurological impairment by the block | First 72 hours from the block |
| D050723 | Fractures, Bone |
| D014947 | Wounds and Injuries |
| D013898 | Thoracic Injuries |
| D010468 | Perceptual Disorders |
| D019954 | Neurobehavioral Manifestations |
| D009422 | Nervous System Diseases |