PVB vs Ketamine/Lidocaine in Rib Fracture Patients

About This Study

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.

Conditions Studied

Interventions

• •lidocaine, ketamine intravenous infusion
• •paravertebral block with ropivicaine

Eligibility

Inclusion Criteria:

* age 18-80 with rib fracture requiring hospitalization
* Failure of standard pain regimen as determined by RR \> 20, TV \< or equal to 50% predicted, NPS \> or equal to 5, Poor cough

Exclusion Criteria:

* age less than 18 years
* greater than 80 years
* GCS less than or equal to 13
* intubated at admission
* prior or anticipated exploratory laparotomy during this admission
* prior or expected thoracotomy during this admission
* prior or expected emergent craniotomy during this admission
* spinal cord injury
* pelvic injury that has required or will require operative intervention
* inability to accomplish activities of daily living independently
* pregnancy
* incarceration

Study Locations (1)