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 for spinal anesthesia. This study focuses on patients requiring spinal anesthesia, including both non-obese and obese individuals, addressing challenges in the traditional landmark palpation technique which can lead to multiple needle insertion attempts and higher risks of complications. The research is conducted in four phases involving technology development and clinical trials to improve accuracy and first-attempt success rates. The study involves applying ultrasound gel to the lower back and using a wireless ultrasound probe to identify spinal landmarks such as the sacrum, L3/4 interspinous space, and ligamentum flavum in real time. In the first phase, the system guides needle insertion in 20 non-obese patients. The second phase scans 50 obese patients to develop an obesity-specific visualization mode without needle insertion. The third phase collects and annotates ultrasound images from 65 obese patients, and the fourth phase assesses the uSINE system's accuracy and first-attempt needle success in another 65 obese patients, with manual needle insertion throughout. Participants will have their lower back scanned with ultrasound while seated, with software guiding the identification of spinal landmarks. The investigators will record outcomes such as the first attempt success rate of spinal anesthesia, number of needle attempts, time to identify ligamentum flavum, and skin-to-ligamentum flavum distance, all monitored within 12 hours post-procedure. The study includes detailed ultrasound imaging, software analysis, and manual needle insertion by anesthetists following routine practice. The total participation timeline varies by study phase and patient group, focusing on improving spinal anesthesia procedures.

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.

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 air/nitrous 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.

Hip surgery is common, especially among elderly patients with multiple health conditions, where managing pain effectively can be challenging due to concerns about side effects and drug interactions. Researchers are evaluating whether the lumbar erector spinae plane block (L-ESP block), an ultrasound-guided regional anesthesia technique, can reduce opioid use and improve pain relief after hip and proximal femur surgeries. Participants will be randomly assigned to receive either the L-ESP block with 30 mL of levobupivacaine 0.25% at the L3-14 level after hip fracture surgery or conventional intravenous pain treatment without the block. The study compares pain reduction and opioid needs following surgery between these two groups. During the study, participants’ pain levels will be measured using the VAS scale within the first two hours after surgery. Researchers will also monitor opioid consumption, technical ease of performing the block, patient satisfaction with pain management, and side effects related to the block and morphine up to 48 hours postoperatively. The trial begins in June 2024 and continues through December 2025.

Researchers are evaluating two methods of epidural analgesia for relieving labor pain: Programmed Intermittent Epidural Bolus (PIEB) and Continuous Epidural Infusion (CEI), both combined with Patient-Controlled Epidural Analgesia (PCEA). This randomized controlled trial aims to compare how well each method controls pain while reducing anesthetic use and preserving maternal motor function. Sixty women in labor at Family Hospital, Da Nang, will be randomly assigned to either the PIEB or CEI group, and outcomes like pain levels, drug consumption, maternal satisfaction, and newborn Apgar scores will be assessed. All participants receive an initial manual epidural dose of 10 mL containing 0.1% Ropivacaine and 2 mcg/mL Fentanyl to start analgesia. The PIEB group then receives automated 8 mL boluses every hour, while the CEI group gets a continuous infusion at 8 mL per hour. Both groups can self-administer 5 mL boluses via PCEA with a 10-minute lockout and a maximum of 20 mL per hour. If pain remains high after two PCEA demands, a 5 mL rescue bolus is given by the anesthesia team. Participants will be monitored for pain intensity at multiple time points up to 4 hours after analgesia starts and during labor stages. Researchers will also measure total anesthetic consumption, maternal motor block incidence, maternal satisfaction, and newborn Apgar scores. Monitoring continues until perineal repair is complete, with assessments up to 24 hours after enrollment. The trial is scheduled to start in July 2025 and end in August 2026.