US-guided SAPB for Rib Fractures in the ED

Summary

The purpose of this randomized controlled study is to determine whether the serratus anterior plane block reduces pain more than the usual treatment for rib fractures in the same amount of time.

Conditions

• Rib Fractures
• Rib Fracture Multiple

Interventions

DRUG

Bupivacaine

Patient will be positioned supine or in the lateral decubitus position on the side contralateral to the fracture(s). A 3.5 in 20-gauge needle, extension tubing, and a 30 mL syringe loaded with 0.25% bupivacaine and 3 mL of 1% lidocaine loaded in a 5 mL syringe with a 27-gauge needle will be prepared. The ribs, teres minor, latissimus dorsi, and serratus anterior will be identified with bedside US and the site of entry marked along the lateral aspect of the 4th-5th rib. The skin will be sterilized and lidocaine placed at the site of entry. The needle will be introduced at a steep angle and advanced in-plane, under US-guidance, to the plane superficial to the serratus anterior muscle. A test dose of normal saline will confirm proper needle tip placement with opening of the intramuscular layer. Injection with aliquots of 3-5 mL after negative aspiration will continue until 30mL of 0.25% bupivacaine are administered.

DRUG

Fentanyl, morphine, hydromorphone, hydrocodone, acetaminophen, ketorolac, gabapentin, ketamine, ibuprofen

Oral or IV pain medication as needed.

Sponsors & Collaborators

• Oregon Health and Science University

  collaborator OTHER

• University of California, Los Angeles

  collaborator OTHER

• Andrew A Herring

  lead OTHER

Principal Investigators

• Andrew Herring, MD · Alameda Health System - Highland Hospital

• Josh Luftig, PA · Alameda Health System - Highland Hospital

• Eben Clattenburg, MD · Alameda Health System - Highland Hospital

• Daniel Mantuani, MD, MPH · Alameda Health System - Highland Hospital

• Arun Nagdev, MD · Alameda Health System - Highland Hospital

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2018-11-06

Primary Completion

2019-08-31

Completion

2019-08-31

FDA Drug

Yes

Countries

• United States

Study Locations