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Leasia, Kiara; Ciarallo, Christopher; Prins, Jonne T H; Preslaski, Candice; Perkins-Pride, Elizabeth; Hardin, Kimberly; Cralley, Alexis; Cothren Burlew, Clay; Coleman, Jamie J; Cohen, Mitchell J; Lawless, Ryan; Platnick, K Barry; Moore, Ernest E; Pieracci, Fredric M
The journal of trauma and acute care surgery, 11/2021, Letnik: 91, Številka: 5Journal Article
Loco-regional analgesia (LRA) remains underutilized in patients with chest wall injuries. Surgical stabilization of rib fractures (SSRF) offers an opportunity to deliver surgeon-directed LRA under direct visualization at the site of surgical intervention. We hypothesized that a single-dose liposomal bupivacaine (LB) intercostal nerve block provides comparable analgesia to an indwelling, peripheral nerve plane analgesic catheter with continuous bupivacaine infusion (IC), each placed during SSRF. Non-inferiority, single center, randomized clinical trial (2017-2020). Patients were randomized to receive either IC or LB during SSRF. The IC was tunneled into the surgical field (subscapular space) and LB involved thoracoscopic intercostal blocks of ribs 3-8. The primary outcome was the Sequential Clinical Assessment of Respiratory Function (SCARF) score, measured daily for 5 days post-operatively. Secondary outcomes included daily narcotic equivalents and failure of primary LRA, defined as requiring a second LRA modality. Thirty-four patients were enrolled; 16 IC and 18 LB. Age, injury severity score, RibScore, Blunt Pulmonary Contusion Score, and use of non-narcotic analgesics was similar between groups. Duration of IC was 4.5 days. There were three failures in the IC group versus one in the LB group (p=0.23). There was no significant difference in SCARF score between the IC and LB groups. On post-operative days 2-4, narcotic requirements were less than half in the LB, as compared to the IC group; however, this difference was not statistically significant. Average wholesale price was $605 for IC and $434 for LB. In this non-inferiority trial, LB provided at least comparable, and potentially superior LRA as compared to IC among patients undergoing SSRF. Level II, Therapeutic.
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Leto | Faktor vpliva | Izdaja | Kategorija | Razvrstitev | ||||
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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in: SICRIS
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