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 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.

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.

Post-dural puncture headache PDPH is a common and painful complication experienced by pregnant patients undergoing cesarean sections with spinal anesthesia. This trial evaluates and compares treatments for acute PDPH using nebulized neostigmineatropine versus lidocaine, alongside standard medical care. The purpose is to find effective treatments to relieve this headache, which occurs due to cerebrospinal fluid leakage causing pain and cerebral blood vessel changes. Participants are randomly assigned to one of three groups a control group receiving saline nebulization twice daily for three days with conventional care a neostigmineatropine group receiving nebulized doses twice daily plus conventional care or a lidocaine group receiving nebulized lidocaine twice daily along with conventional care. Conventional care includes bed rest, hydration through lactated Ringer solution infusion, paracetamol every 6 hours, and diclofenac suppositories as routine post-operative pain management. During the study, participants will be monitored for headache severity using the Visual Analog Scale at multiple time points up to 120 hours post-intervention. Additional assessments include headache classification, need for epidural blood patch, and neurological and procedural complications. Transcranial Doppler ultrasound scans will be performed at different intervals to observe cerebral blood flow. The study is double-blinded and aims to complete by early 2027, with participants involved for several days of treatment and follow-up.

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.

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.

This research aims to investigate whether providing preemptive education by anesthesiologists can reduce the occurrence of maternal shivering during elective cesarean delivery. The study focuses on women undergoing this specific surgical procedure and seeks to answer if informing patients ahead of time about the anesthesia and surgery process affects intraoperative shivering. The trial is randomized and triple-blinded to ensure unbiased results and is sponsored by Seoul National University Hospital. Participants are divided into two groups one group receives minimal information about the surgery with questions answered by the obstetrician, while the other group receives detailed preemptive education about the entire processfrom anesthesia through recoveryprovided by anesthesiologists in a 15-minute session. The study compares the effect of this education on maternal shivering during surgery. During the study, researchers will monitor participants from the moment they enter the operating room until they leave, which may last up to 180 minutes. They will measure the number of women experiencing shivering, body temperature, pain levels, and spinal anesthesia effects at various time points during and after surgery. Additional assessments include post-operative shivering, nausea, patient satisfaction, pain and analgesic use up to one day after surgery, and obstetric recovery quality. This thorough monitoring helps evaluate the full impact of preemptive education on the surgery experience and recovery.

This research aims to evaluate whether the transverse diameter of the right common femoral vein RCFV measured by ultrasound can predict the degree of low blood pressure hypotension during spinal anesthesia in elderly patients undergoing elective orthopedic surgery. Spinal anesthesia often causes hypotension, especially in older adults who have reduced heart and blood vessel function. Previous studies mainly focused on pregnant women having cesarean deliveries, so this study seeks to understand its usefulness in a different high-risk group. Participants will have their RCFV diameter measured 1 cm above the junction with the great saphenous vein at the end of expiration using ultrasound before their surgery. The study involves patients scheduled for elective lower-limb orthopedic surgery under spinal anesthesia. No experimental treatments are given, as this is an observational study assessing the relationship between vein diameter and blood pressure changes. During the study, researchers will monitor blood pressure closely up to 15 minutes after spinal anesthesia to assess the predictive ability of the femoral vein diameter. They will also record the severity of hypotension, any adverse events, and the use of rescue medications during the first 24 hours after surgery. Participants will be observed throughout their surgery and recovery period to collect these measurements. The study will last until July 2026, starting in December 2025.