Lumbar Puncture

Researchers are evaluating a modified lumbar puncture (LP) procedure designed to reduce the occurrence of post-lumbar puncture headaches (PLPH) in adult patients. This study aims to determine if this modified procedure can lower the incidence of PLPH to 5% or less, reduce the use of epidural blood patches (EBP) to 10% or less among those with PLPH, and identify factors influencing PLPH occurrence. The modified LP procedure involves using a 22 gauge Quincke spinal needle without reinserting the stylet after cerebrospinal fluid collection before removing the needle. Participants will undergo this modified procedure as part of their diagnostic or therapeutic care. The study is prospective and single-arm, focusing on adult patients receiving lumbar punctures according to standard medical care. Participants will be assessed for headaches at multiple time points: 30 to 60 minutes, 1 day, 3 days, and 5 days after the procedure using questionnaires. Use of epidural blood patches will also be tracked at 1, 3, and 5 days post-LP. Participants must be able to consent and comply with study procedures, with their performance status considered. The total duration and follow-up details align with the scheduled assessments after the LP procedure.

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.

Researchers are studying idiopathic normal pressure hydrocephalus (iNPH) and related disorders to understand their clinical characteristics and natural progression. This prospective single-center study aims to identify digital, imaging, and molecular biomarkers that can help with diagnosis and therapy development. It also explores the causes and molecular mechanisms of these conditions to better understand their effects and outcomes. Participants are divided into groups including those diagnosed with hydrocephalus and a normal group. The study involves advanced diagnostic tests such as high throughput sequencing, whole genome and exome sequencing, transcriptomics, proteomics, metabolomics, and imaging techniques like DTIALPS. These tests are conducted to gather comprehensive data on the disease and its biomarkers. During study visits, patients undergo standardized clinical examinations and complete clinical rating scales. Biosamples such as blood, urine, cerebrospinal fluid, and muscle biopsies may be collected optionally. Additional assessments like neurophysiological exams, patient-reported outcomes, and imaging are also performed. Researchers measure changes from baseline in DTIALPS imaging and various clinical scales six months after ventriculoperitoneal shunt surgery. The study includes monitoring cognitive function, gait, and molecular patterns, with participation lasting through these assessments and follow-ups.

This research aims to compare cerebrospinal fluid (CSF) samples taken from two different sites on external ventricular drains (EVDs) used in patients with conditions such as brain bleeding, head trauma, or tumors. The goal is to see if sampling CSF distally (farther from the brain) provides similar results to proximal sampling (closer to the brain). If proven similar, distal sampling could reduce risks like infection or brain injury associated with proximal sampling. Patients with EVDs currently undergo routine CSF sampling two to three times a week to monitor protein, glucose, lactate levels, and cell counts, helping detect infections and guide treatment decisions. This study evaluates CSF collected both proximally, near the brain, and distally, near the collection bag, to assess differences. Distal sampling may lower risks and allow nurses or other physicians to perform sampling instead of neurosurgeons. Participants will have CSF samples collected every 2-3 days from the time the EVD is placed until it is removed, estimated between 7 and 28 days. Researchers will analyze and compare white and red blood cell counts, protein, glucose, lactate levels, cultures, and gram stains from both sampling sites over time. Safety concerns like infections or new bleeding events related to sampling will also be monitored throughout the study duration.

Post-dural puncture headache (PDPH) is a common and painful problem that can happen after spinal anesthesia in pregnant women having cesarean sections. It is caused by leakage of cerebrospinal fluid after a lumbar puncture, leading to headache due to brain tension and blood vessel changes. This trial studies the effects of nebulized neostigmine/atropine compared to nebulized lidocaine and placebo, aiming to find better treatments for PDPH in women aged 18 to 35 years undergoing elective cesarean sections. Participants are randomly assigned to one of three groups: one group receives nebulized saline as a placebo, another receives nebulized neostigmine and atropine, and the third group receives nebulized lidocaine. Each treatment is given twice daily for three days alongside standard care, which includes bed rest, hydration with lactated Ringer solution, paracetamol every six hours, and diclofenac suppositories for pain relief. The study compares these treatments to evaluate their effects on headache severity and other outcomes. During the trial, participants will be monitored through visual analog scale (VAS) scores for headache pain over three days, Lybecker headache classification, need for epidural blood patches, and complications over several days. Transcranial Doppler scans will be performed at the start and during follow-up to assess cerebral blood flow. Hospital stay length and neural complications will also be recorded. The total study period includes treatment and follow-up assessments to evaluate safety and effectiveness of the interventions.

Lower segment cesarean section is a common surgery performed worldwide, usually under spinal anesthesia. This anesthesia involves injecting a local anesthetic near the spinal cord to block nerve signals, providing pain relief during and shortly after surgery while avoiding drug exposure to the baby. The study evaluates whether adding the steroid drug dexamethasone can prolong the duration of this spinal anesthesia and pain relief for pregnant patients during cesarean sections. The study compares two groups: one receiving 8 mg of dexamethasone intravenously immediately after the spinal anesthesia, and the other receiving a placebo of normal saline. This drug is known for its anti-inflammatory and anti-nausea effects and is being assessed here as an add-on to potentially extend anesthesia duration and post-operative pain relief. The trial is randomized and double-blind, meaning neither patients nor researchers know which treatment is given. Participants will be monitored for how long the spinal block lasts after surgery, specifically measuring the time until the anesthesia effect decreases by two dermatomes. Researchers will also track the time until participants request additional pain medication. Safety, pain levels, and other outcomes will be assessed during and after the procedure. The study includes women aged 16 to 40 undergoing elective cesarean sections under spinal anesthesia and will follow them through the surgical and recovery periods.

This research aims to compare the effects of adding dexamethasone or magnesium sulfate to bupivacaine during bilateral erector spinae plane blocks for controlling pain after cesarean section under spinal anesthesia. The study focuses on women undergoing elective cesarean delivery and explores ways to improve postoperative pain management, which is important to support recovery and reduce complications like chronic pain and stress. Participants will be divided into three groups: one receiving 20 ml of 0.25% isobaric bupivacaine alone, another receiving 20 ml of the same bupivacaine plus 4 mg dexamethasone, and the third receiving 20 ml of bupivacaine with 200 mg magnesium sulfate. These treatments are delivered using ultrasound-guided erector spinae plane blocks during surgery. During the study, participants will be monitored for pain control, time to first need for additional pain relief, total morphine consumption, ability to move independently, and any complications within 24 hours after surgery. Researchers will assess pain levels, quality of recovery, and safety outcomes to evaluate the effects of the added medications. The study period includes immediate postoperative assessments and follow-up within the first day after cesarean delivery.

Researchers are studying the effects of altitude on the occurrence and severity of postdural puncture headache (PDPH) after spinal anesthesia during caesarean delivery. This observational study compares women living at high altitude (above 2500 m) with those living at low altitude (below 500 m) in Nepal. The goal is to understand if living at higher elevations increases the risk of PDPH following spinal anesthesia. The study involves two groups: parturients native to high altitudes and those native to low altitudes, both receiving spinal anesthesia for caesarean section using a 25-gauge pencil point spinal needle. Researchers will collect baseline information including anxiety, depression, chronic pain, or previous headaches. The diagnosis of PDPH will follow international headache criteria and will be assessed up to 7 days after spinal anesthesia. Participants will be monitored for headache occurrence, severity, and whether treatments were needed within one month after PDPH onset. Data on other types of headaches will also be collected. The study will record patient characteristics and anesthesia details, with follow-up for up to one month after delivery. Participants will be observed for any complications, and results will help clarify how altitude influences PDPH risk.

This research aims to investigate the effects of drinking coffee after surgery on postdural puncture headache (PDPH) and pain medication use in women who have cesarean sections with spinal anesthesia. PDPH is a common complication after spinal anesthesia, which is preferred for its pain control benefits and fewer opioid needs. Caffeine may help relieve headaches due to its effects on blood vessels and inflammation, but its role in preventing PDPH is not yet clear. Participants will be randomly assigned to one of two groups. One group will consume coffee four times within 48 hours after surgery, starting with the first coffee within the first hour after beginning oral feeding. Coffee dosing is scheduled based on surgery time and individual preferences. The other group will receive standard postoperative care without coffee. The study is designed to compare these two approaches in women undergoing cesarean section with spinal anesthesia. During the study, participants will be monitored for the occurrence and severity of PDPH from 6 hours after surgery up to 5 days afterward. Researchers will also track postoperative use of pain medications and measure patient satisfaction before hospital discharge. The study includes assessments of headache symptoms and analgesic use to understand how coffee consumption might affect recovery. The total participation period involves these evaluations over several days following the cesarean section.

Researchers are evaluating the effects of binaural beat music played during spinal anesthesia knee arthroplasty on anxiety, pain, and cortisol levels. This randomized controlled experimental study aims to understand whether this music intervention can influence these factors, which are important because pain and anxiety can affect surgery outcomes and recovery. The study involves 40 patients divided into two groups: one receiving binaural beat music during surgery and one receiving routine care without music. In the intervention group, patients will listen to specially designed binaural beat music through headphones during the surgical procedure. This music, set at a maximum of 60 dB and combined with natural sounds like birdsong and waterfalls, is intended to relax and reduce stress. The control group will receive standard care without music. Binaural beat music will start when surgery begins and end when surgery ends. The study is double-blinded and randomized with two groups: intervention and control. Participants will be interviewed before surgery to collect baseline data and anxiety levels using the State Anxiety Inventory Form. Hemodynamic data will be recorded immediately before and after surgery. After surgery, anxiety, pain levels using the Visual Analog Scale, and cortisol levels via blood samples will be measured. Researchers will monitor these outcomes through study completion, averaging about two months. This study also includes safety monitoring and excludes patients who have contraindications for spinal anesthesia or complications during surgery.