The RESPIRO trial is a multicentre, randomised, double-blind, intention to treat study. In patients with rib fractures and pulmonary contusions severe pain significantly limits the ability to cough and breathe deeply. Adequate analgesia is vital to functional recovery after rib fractures and prevention of respiratory morbidity. Erector spinae plane (ESP) catheter provide an alternative regional technique for analgesia by infusion of local anaesthesia between the erector spinae muscle and transverse process of the vertebrae. ESP catheters were associated with improved inspiratory capacity measured using spirometry and analgesic outcomes following rib fracture.
Currently, there is a lack of uniformity and consensus on the best regimen for local anaesthesia infusion: whether using a programmed intermittent bolus (PIB), or a continuous infusion (CI), regimen. The two regimens have been compared in a variety of continuous nerve blocks techniques with variable results. Theoretical and anatomical considerations, with initial confirmation by in vitro cadaveric and low-quality evidence clinical studies, suggest that PIB provides better local anaesthesia spread.
This study will evaluate if PIB is superior to CI via ESP catheters using clinically relevant outcomes of pain scores, opioid consumption, and improved respiratory function.
Dr Tim Joseph, Nepean Hospital, NSW,
Dr Ben Moran, Gosford Hospital, NSW,
Associate Professor Alwin Chuan, Liverpool Hospital, NSW
The project was awarded A$54,255 funding through the ANZCA research grants program for 2024.