Effect of early analgesia with erector spinae plane block to reduce ventilation after severe chest trauma: the multicentre randomised controlled TARGET study protocol.

Abstract

Blunt chest trauma is frequently associated with rib fractures, and inadequate pain control may lead to respiratory complications and prolonged ventilatory support. In spontaneously breathing patients, pain impairs coughing and secretion clearance, promoting atelectasis and respiratory failure, while in mechanically ventilated patients, it may delay weaning. Current French guidelines recommend intravenous multimodal analgesia as first-line therapy followed by thoracic epidural or paravertebral block if pain remains uncontrolled. However, these techniques have limited applicability in the trauma setting. The erector spinae plane (ESP) block is a simpler ultrasound-guided regional analgesia technique with fewer contraindications. Although retrospective data suggest potential respiratory benefits, its efficacy has not been evaluated in randomised controlled trials. This study aims to assess whether early initiation of a continuous ESP block reduces ventilatory support duration after blunt chest trauma. The EffecT of eARly analGesia with ErecTor spinae plane block (TARGET) trial is a multicentre, superiority, randomised controlled trial including adult patients (≥18 years) with blunt chest trauma and at least three rib fractures on thoracic CT scan requiring intensive care unit admission. Participants are randomised to receive either early continuous ESP block initiated within 6 hours of admission or standard intravenous multimodal analgesia with escalation to thoracic epidural or paravertebral block if indicated. The primary outcome is the number of days alive and free from invasive or non-invasive curative ventilation within 30 days after randomisation or hospital discharge. Randomisation is stratified by centre and age (<65 or ≥65 years). Investigators and outcome assessors are not blinded. A total of 400 patients will be included. The study has been approved by the ethics committee <i>CPP Sud-Ouest IV</i> on 17 April 2023 (approval number 23.00675.000144). The study began on 22 October 2023. Results will be disseminated through publication in a peer-reviewed international medical journal. ClinicalTrials.gov: NCT05920109.