Lidocaine + Ketamine vs Paravertebral Block for Rib Fractures
Trial Summary
What is the purpose of this trial?
Rib fractures are a common admission to the trauma service. The mainstay of treatment is pain control to improve respiratory effort in order to offset the risk of pneumonia and mechanical ventilation. In addition to standard pain control modalities, the investigator's institution utilizes paravertebral blocks as well as lidocaine and ketamine infusions for pain control. The current standard of care for pain control is to begin with acetaminophen, ibuprofen or celecoxib and opioids with the addition of paravertebral blocks as needed. In certain situations, a paravertebral block is contraindicated, and pain control is relegated to lidocaine and ketamine infusion. The use of lidocaine infusion alone and ketamine infusion alone for pain control has been studied and has been shown to be safe. However, concurrent use of these two medications to control rib fracture pain is relatively new and the efficacy compared to paravertebral block is not known. The goal of the study is to show non-inferiority of simultaneous lidocaine and ketamine infusions versus paravertebral blocks.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your doctor.
What data supports the effectiveness of the treatment Lidocaine + Ketamine vs Paravertebral Block for Rib Fractures?
Is the combination of Lidocaine and Ketamine or Paravertebral Block with Ropivacaine safe for treating rib fractures?
Paravertebral Block with Ropivacaine has been studied for pain relief in various surgeries and conditions, showing it can be effective and generally safe, though high doses may risk local anesthetic toxicity. Adjusting doses or combining with other drugs like fentanyl can help reduce this risk.12467
How does the treatment of Lidocaine + Ketamine infusions compare to Paravertebral Block with Ropivacaine for rib fractures?
The treatment using Lidocaine and Ketamine infusions is unique because it combines two drugs that work together to manage pain, potentially offering a different mechanism of action compared to the Paravertebral Block with Ropivacaine, which involves injecting a local anesthetic near the spine to block pain from the ribs. This approach may provide an alternative for patients who cannot receive or do not respond well to traditional nerve blocks.12489
Eligibility Criteria
This trial is for adults aged 18-80 hospitalized with rib fractures who haven't had relief from standard pain treatments. It's not for those under 18 or over 80, pregnant women, patients with severe head injuries, spinal cord or serious pelvic injuries, those needing major surgery like laparotomy or thoracotomy during the stay, intubated patients at admission, or prisoners.Inclusion Criteria
Exclusion Criteria
Timeline
Screening
Participants are screened for eligibility to participate in the trial
Treatment
Participants receive either paravertebral block with ropivacaine or simultaneous ketamine and lidocaine infusions for pain management
Follow-up
Participants are monitored for safety and effectiveness after treatment, including assessment of pain scores and opioid usage
Treatment Details
Interventions
- Lidocaine and Ketamine Infusions
- N/A
- Paravertebral Block with Ropivacaine
Find a Clinic Near You
Who Is Running the Clinical Trial?
George Washington University
Lead Sponsor