{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:39:57Z","timestamp":1785519597787,"version":"3.56.0"},"reference-count":17,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"unspecified","delay-in-days":30,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"French Ministry of Health (Direction G\u00e9n\u00e9rale de l\u2019Offre de Soins: Programme Hospitalier de Recherche Clinique National","award":["PHRC-21-0018"],"award-info":[{"award-number":["PHRC-21-0018"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,14]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The EffecT of eARly analGesia with ErecTor spinae plane block (TARGET) trial is a multicentre, superiority, randomised controlled trial including adult patients (\u226518 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\u2009hours 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 (&lt;65\u2009or \u226565 years). Investigators and outcome assessors are not blinded. A total of 400\u2009patients will be included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>\n                      The study has been approved by the ethics committee\n                      <jats:italic>CPP Sud-Ouest IV<\/jats:italic>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial results\" xlink:href=\"NCT05920109\">NCT05920109<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-117195","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T16:50:14Z","timestamp":1785516614000},"page":"e117195","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of early analgesia with erector spinae plane block to reduce ventilation after severe chest trauma: the multicentre randomised controlled TARGET study protocol"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct05920109","registry":"10.18810\/clinical-trials-gov","type":"results"},{"clinical-trial-number":"nct05920109","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05920109","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4667-6738","authenticated-orcid":false,"given":"Pierre","family":"Bouzat","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, Universit\u00e9 Grenoble Alpe, INSERM U1216, CHU Grenoble, Alpes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anais","family":"Adolle","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, CHU Grenoble Alpes, Grenoble, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Gauss","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, Universit\u00e9 Grenoble Alpe, INSERM U1216, CHU Grenoble, Alpes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Perreira","sequence":"additional","affiliation":[{"name":"Biostatistics Unit, Department of Clinical Research and Innovation, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Michel","family":"Constantin","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, Assistance Publique\u2014H\u00f4pitaux de Paris (APHP), H\u00f4pital La Piti\u00e9 Salp\u00eatri\u00e8re, Sorbonne Universit\u00e9, Paris, 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oncologic breast surgeries: a systematic review and network meta-analysis of randomized controlled trials","volume":"69","author":"Singh","year":"2022","journal-title":"Can J Anaesth"},{"key":"2026073109500672000_16.7.e117195.11","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1093\/pm\/pnab214","article-title":"The Effect of Erector Spinae Block versus Serratus Plane Block on Pain Scores and Diaphragmatic Excursion in Multiple Rib Fractures. 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