Epidural

Researchers are studying the effects of Huperzine A Injection on reducing postoperative delirium in elderly patients aged 75 and older who are undergoing non-cardiac surgery. This randomized, double-blinded, placebo-controlled trial aims to observe how this treatment may influence the occurrence of delirium after surgery in this older population. Participants will be randomly assigned to receive either Huperzine A Injection or a placebo of 0.9% Sodium Chloride Injection during their non-cardiac surgical procedure. The study includes patients with an anesthesia grade of III to IV and an estimated operation time of at least 2 hours. The treatments will be administered under controlled conditions to carefully assess their effects on postoperative delirium. During the study, participants will be monitored for delirium incidence within 7 days after surgery, with additional evaluations at 24, 48, and 72 hours post-operation. Researchers will also assess the type, severity, and duration of delirium, length of hospital stay, economic costs, complications, mortality rates, and cognitive function using the Mini-mental State Examination and EuroQol scale. Follow-up assessments will continue up to 2 months after surgery, with some evaluations occurring around 30 days after discharge.

Researchers are conducting a prospective, multicenter, randomized controlled study to evaluate treatment options for patients diagnosed with acute epidural hematoma confirmed by cranial CT. The study aims to compare the effects of middle meningeal artery embolization combined with conservative treatment versus conservative treatment alone. The primary goal is to assess the proportion of patients requiring craniotomy within 7 days after injury and to measure neurogenic death within 28 days. Secondary outcomes include changes in hematoma volume, Glasgow Coma Scale GCS scores, hospitalization duration, rehabilitation outcomes, re-hospitalizations, and quality of life scores up to 6 months after injury. Participants will be randomly assigned to one of two groups the intervention group receiving middle meningeal artery embolization within 2 hours of enrollment plus standard conservative treatment, and the control group receiving only the best conservative treatment as recommended by clinical guidelines. Conservative treatment includes medication such as hemostatic, antihypertensive, and symptomatic therapies, consistent across both groups. Treatment must start within 8 hours after injury, with randomization occurring within 6 hours. The study plans to enroll 194 patients, evenly split between the two groups. During the study, patients will undergo neurological examinations and measurements of hematoma size at multiple time points, including 7 days, 28 days, 3 months, and 6 months after injury. Researchers will monitor clinical outcomes such as ICU and total hospitalization days, discharge destinations, and adverse events including surgical complications and mortality rates. Glasgow Outcome Scale-Extended GOSE and EQ-5D quality of life scores will be assessed at 3 and 6 months. Safety monitoring includes tracking serious adverse events and all-cause mortality over the study period. Participants will be followed closely for up to 6 months to evaluate recovery and treatment impact.

Researchers are evaluating an ultrasound guided automated spinal landmark identification system called uSINE to improve the safety and success of neuraxial needle insertion during spinal anesthesia. The study addresses limitations of the traditional blind palpation method, which can lead to multiple needle insertion attempts and complications. This study involves four phases focusing on technology development and clinical evaluation, especially in obese patients where anatomy is more challenging. The study uses ultrasound gel and a wireless ultrasound probe to scan the lumbar spine and identify spinal landmarks in real-time. In the first phase, 20 non-obese patients undergoing neuraxial anesthesia will have the system used to guide needle insertion. The second phase involves scanning 50 obese patients backs without needle insertion to develop an obesity-specific visualization mode. The third and fourth phases involve collecting ultrasound images and testing the systems accuracy and first-attempt success rate in 65 obese patients. Participants will assume a seated position for ultrasound scanning of the lower back. The procedure includes longitudinal and transverse scans to identify the sacrum, interspinous spaces, and ligamentum flavum. The primary outcome is the first attempt success rate of spinal anesthesia, measured within 12 hours. Secondary outcomes include the number of attempts, time to identify ligamentum flavum, and distance from skin to ligamentum flavum. The study monitors all phases until completion planned by the end of 2027.

The trial investigates pain management after mastectomy for breast cancer, focusing on comparing two regional analgesia techniques. It aims to evaluate the pain relief and quality of recovery between a combined Pectoral Nerve II PECS II and Superficial Parasternal Intercostal Plane PIP block versus the standard Thoracic Paravertebral Block TPVB. This study addresses risks related to TPVB and explores whether the combined blocks can provide effective pain control with fewer complications. Participants are randomly assigned to one of two groups following general anesthesia induction one receiving the combined ultrasound-guided PECS II and PIP blocks with specific doses of 0.25% Bupivacaine, and the other receiving the ultrasound-guided TPVB at thoracic levels T4 and T6. Both groups receive standardized general anesthesia and intraoperative monitoring. Postoperative pain management includes oral paracetamol, IV ketorolac, and IV Morphine via patient-controlled analgesia PCA. During the 24-hour postoperative period, participants have their pain levels assessed at rest and movement using the Numeric Rating Scale NRS at multiple time points. Researchers also measure total opioid use, time to first analgesic request, and quality of recovery using the QoR-15 questionnaire. Monitoring for complications related to nerve blocks, such as local anesthetic toxicity and pneumothorax, is conducted, ensuring comprehensive safety and efficacy evaluation throughout the study.

Total knee arthroplasty TKA is a common surgery for severe osteoarthritis when other treatments do not work. However, many patients experience significant pain after surgery, which can slow recovery and increase opioid use. Researchers are studying different doses of liposomal bupivacaine in the adductor canal block, a pain relief technique, to see how it affects pain and opioid use after robotic-assisted TKA. This is a randomized controlled trial sponsored by The University of Hong Kong. Participants will receive one of three treatments during surgery an adductor canal block with standard bupivacaine, a combination of liposomal and standard bupivacaine, or liposomal bupivacaine alone in different doses. The study will compare the effects of these doses on pain relief and opioid consumption. The trial uses a triple-blind method and includes detailed monitoring of drug levels, pain scores, and recovery measures. During the study, participants will have their pain levels measured frequently for up to 7 days after surgery, along with assessments of knee function, opioid side effects, and quality of recovery. Blood samples will be taken to check bupivacaine levels. Long-term outcomes such as chronic pain, knee function, and quality of life will be evaluated at 6 weeks, 3 months, and 6 months post-surgery. The primary outcome is the overall pain score at rest during the first 48 hours after surgery.

This observational study focuses on the communication between anesthesiologists and patients during the process of labor neuraxial analgesia. Researchers aim to understand how anesthesiologists differ in explaining the procedure, including its technical aspects, alternatives, risks, complications, and expected effects. The study will observe routine care given to healthy, uncomplicated patients during labor. All anesthesiologists providing labor neuraxial analgesia will be observed as they carry out their standard clinical consent process. There are no experimental treatments or interventions involved, as this study purely reviews communication and consent practices during usual care. The study does not alter any procedures but collects data on how information is conveyed. Participants will be monitored from the first contact with the anesthesiologist before the analgesia begins until the procedure finishes. Researchers will assess the informed consent process and how well anesthesiologists describe the procedure, risks, alternatives, anticipated effects, and provide patient information sheets. The study is designed to improve understanding of communication in this important clinical setting.

Researchers are evaluating a new technique called the Biceps Femoris Short Head BiFeS block, combined with the adductor canal block ACB, for pain relief after total knee arthroplasty, a surgery to treat advanced osteoarthritis. This study compares the BiFeS block plus ACB to the ACB plus iPACK block, aiming to find which combination provides better postoperative pain control while preserving motor function. The trial is designed as a prospective, randomized, double-blind study involving two groups of patients undergoing knee replacement surgery. Participants will be randomly assigned to receive either the ACB combined with the iPACK block or the ACB combined with the BiFeS block. Both blocks use ultrasound guidance to inject bupivacaine anesthetic near specific nerves around the knee to reduce pain without affecting muscle strength. The BiFeS block targets sensory nerves around the posterolateral knee capsule. The study carefully monitors and compares the effectiveness of these two motor-sparing regional anesthesia techniques during and after surgery. During the trial, participants will have pain scores measured at multiple time points up to three months after surgery, including rest and movement pain levels. Researchers will also track opioid use, time to rescue pain medication, early mobilization, quality of recovery, and any complications like nausea or vomiting. Assessments include questionnaires and physical therapy criteria for hospital discharge. The total follow-up period extends to three months, allowing detailed evaluation of pain control and functional recovery after knee replacement surgery.

Researchers are investigating the use of bupivacaine liposomes combined with bupivacaine versus bupivacaine alone for ultrasound-guided bilateral costal margin block CMB to manage postoperative pain in patients undergoing laparoscopic liver, gallbladder, and pancreatic surgery. This phase 4 randomized, single-blind clinical trial aims to evaluate if adding bupivacaine liposomes can better reduce opioid use after surgery compared to bupivacaine alone. The study addresses the need for effective regional analgesia techniques in upper abdominal surgeries, where current blocks may not fully relieve pain from anterior and outer abdominal wall incisions.

Hypospadias is a common genital malformation in boys that is usually treated with surgery. Researchers are evaluating whether caudal anesthesia compared to dorsal penile block anesthesia affects the rate of surgical complications like urethrocutaneous fistulas and glans dehiscence after hypospadias repair. This pilot randomized controlled trial aims to determine if one anesthesia method leads to fewer complications and to test the feasibility of a larger study. Participants aged 6 to 48 months undergoing distal hypospadias repair will be randomly assigned to receive either a caudal block or a dorsal penile block anesthesia. Both methods use inhalation induction with airnitrous oxide and sevoflurane followed by an injection of bupivacaine without epinephrine. Additional pain management includes fentanyl, dexamethasone, ondansetron, acetaminophen, morphine, and post-discharge medications such as oral morphine, Ditropan, Tylenol, ibuprofen, and trimethoprim until catheter removal. During the study, children will be closely monitored for postoperative complications for up to one year. Researchers will assess safety and complication rates, medication usage, and recovery progress. This double-blind, randomized trial will provide detailed data on the impact of anesthesia type on surgical outcomes and help guide future treatment decisions.

This research aims to evaluate the safety and effectiveness of a combined subcostal and lateral transversus abdominis plane TAP block compared with thoracic epidural anesthesia TEA for pain relief after major abdominal cancer surgery. Postoperative pain is commonly managed by various methods, with TEA traditionally considered the standard due to its reliable pain control and additional benefits like reduced intestinal blockage and better lung function. TAP blocks are increasingly important in pain management and recovery protocols following surgery. Participants will be randomly assigned to one of two groups one receiving an ultrasound-guided combined subcostal and lateral TAP block, and the other receiving an ultrasound-guided thoracic epidural anesthesia. Both methods involve precise ultrasound guidance to deliver anesthesia and are studied to compare their effects on postoperative pain control after major abdominal surgeries such as gastrectomy, colectomy, or hepatectomy. During the study, participants will be monitored for total morphine use within 24 hours after surgery, time to first need for additional pain relief, blood pressure and heart rate during surgery, level of pain after 24 hours, and any side effects occurring after surgery. The study includes double-blind procedures and random assignment, with follow-up assessments focused on safety and pain management outcomes. The trial is sponsored by Assiut University and will run until April 2026.