Placebo-controlled randomized double-blind comparison of the analgesic efficacy of lidocaine spray and etofenamate spray in pain control of rib fractures.
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2024;12(5):21 Ulus Travma Acil Cerrahi Derg . 2023 Aug;29(8):929-934.What this means for my practice?
In patients over 18 years of age with isolated rib fractures, there was no significant difference between two analgesic sprays and a placebo spray used together with standard dexketoprofen 50- mg IV treatment. Moderate, although not statistically significant, improvements in pain reduction and rescue medication need was observed in the LS group at 120 minutes with no side effects. The study was limited by being single centered and due to the administration of dexketoprofen prior to using the spray. Further placebo-controlled research investigating lidocaine spray for the pain management of rib fractures is warranted.
Study Summary
84 patients over 18 years of age with isolated rib fractures were included in this single center, prospective, placebo controlled, double blind trial. Patients were randomly allocated to receive either 10% lidocaine spray (LS; n=29), etofenamate spray (ES; n=28) or placebo spray (PS; n=27). The primary outcome of interest was pain intensity measured using a numerical rating scale (NRS) at baseline, and 15, 30, 60 and 120 minutes. Other outcomes of interest included rescue medication requirements and adverse events. Study findings suggest that all three groups demonstrated similar NRS scores, with no significant difference in pain reduction found at any timepoint. The maximum reduction was seen in the LS group between baseline and 120 minutes, however this difference was not statistically significant. It was also seen that the need for rescue medication was lowest in the LS group; a difference that was found to be clinically significant but not statistically significant. Importantly, only one adverse event was reported with one patient in the ES group showing signs of redness.
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