Traumatic rib fractures cause severe chest wall pain that can impair normal breathing, coughing, and lung function. While systemic opioids are commonly used to treat traumatic pain, their side effects, such as sedation and respiratory depression, can complicate recovery. Regional nerve blocks like the ultrasound-guided erector spinae plane block (ESPB) offer targeted pain relief while minimizing opioid requirements.
The purpose of this clinical trial is to compare the analgesic efficacy and respiratory outcomes of adding dexmedetomidine versus dexamethasone to bupivacaine during an ultrasound-guided ESPB in emergency department patients with acute traumatic rib fractures.
Participants aged 18 to 65 years presenting within 24 hours of rib injury will be randomly assigned to one of two groups:
* Dexmedetomidine Group: Receives an ultrasound-guided ESPB with bupivacaine plus dexmedetomidine. * Dexamethasone Group: Receives an ultrasound-guided ESPB with bupivacaine plus dexamethasone.
The primary outcome is the duration of analgesia, measured as the time to the first request for rescue pain medication. Secondary outcomes include pain scores at rest and during coughing/deep breathing, total 24-hour opioid consumption, diaphragmatic motion evaluated by ultrasound, respiratory recovery, and the incidence of adverse events over a 24-hour follow-up period.
Adult patients aged 18 to 65 years
Both sexes
American Society of Anesthesiologists (ASA) physical status I-II
Acute traumatic rib fractures confirmed by appropriate imaging
Patient refusal to participate
Immediate need for endotracheal intubation or invasive mechanical ventilation prior to randomization or block placement
Hemodynamic instability requiring immediate resuscitation or vasopressor support precluding safe regional anesthesia
Cardiorespiratory arrest or peri-arrest status
Parallel
Dexmedetomidine with Bupivacaine in ESPB
DrugUltrasound-guided thoracic erector spinae plane block (ESPB) administered deep to the erector spinae muscle and superficial to the transverse process (typically T4-T6) using bupivacaine supplemented with dexmedetomidine (0.5 mcg/kg) following local skin infiltration with 5 mL of 2% lidocaine.
Dexamethasone with Bupivacaine in ESPB
DrugUltrasound-guided thoracic erector spinae plane block (ESPB) administered deep to the erector spinae muscle and superficial to the transverse process (typically T4-T6) using bupivacaine supplemented with dexamethasone (4 mg) following local skin infiltration with 5 mL of 2% lidocaine.
Time to First Rescue Analgesic Request
Time (in minutes) from the completion of the ultrasound-guided erector spinae plane block until the patient's first request for rescue analgesia (or when the Numeric Rating Scale score is 4 or greater).
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