Dharan

This research aims to compare the effects of submucosal dexamethasone and oral trypsin-chymotrypsin on reducing common postoperative problems like pain, swelling, and difficulty opening the mouth after surgical removal of impacted lower third molars. These issues arise mainly from local inflammation after surgery. The study evaluates how these treatments work to control inflammation and improve recovery. Participants will receive one of two treatments a local injection of 8 mg dexamethasone given under the mucosa near the surgery site before the incision, or oral trypsin-chymotrypsin tablets taken starting 30 minutes before surgery and then three times daily for five days after extraction. The dexamethasone injection focuses the drug near the affected area with minimal systemic absorption, while the oral enzyme therapy aims to break down inflammatory peptides. Participants will be monitored for three months to compare how well each treatment reduces postoperative symptoms. Researchers will assess clinical signs of inflammation, including pain, swelling, and trismus. The study includes regular evaluations to track healing and any side effects. The trial uses a randomized design with single masking to ensure objective comparison of the two treatments.

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 evaluate the use of a lower international normalized ratio INR target range of 1.5 to 2.5 in patients with a mechanical bileaflet heart valve placed in the aortic position. The study seeks to determine whether lowering the INR target can reduce bleeding risks without increasing the chance of blood clots or stroke. This is important because patients with mechanical heart valves require lifelong warfarin Coumadin treatment to prevent clot formation, but managing the right balance between clot prevention and bleeding risk remains challenging. Participants will be randomly assigned to one of two groups. One group will receive warfarin therapy adjusted to a lower INR target range of 1.5 to 2.5, while the other group will have warfarin adjusted to a standard INR target range as currently recommended. Both groups will receive warfarin after their mechanical valve implant, but the INR targets for blood thinning will differ. The study includes follow-up over an expected mean of 2 to 3 years to monitor outcomes. During the study, participants will be regularly monitored for blood clot events such as thrombosis or stroke, as well as bleeding episodes, including major and minor bleeding. Researchers will track various outcomes like mortality, different types of stroke, heart attacks, pulmonary embolism, and kidney function over the study period. Time in the therapeutic INR range and occurrences of extreme INR values will also be recorded. Participants will be followed through the study duration, which will help determine the safety and risk balance of using a lower INR target in this patient group.

Researchers are evaluating the effect of an intravenous lidocaine infusion during breast cancer surgery to reduce the development of persistent pain three months after surgery. This international Phase III randomized controlled trial involves 1,602 patients undergoing various types of breast cancer surgery, including lumpectomy and mastectomy, and aims to compare lidocaine infusion with a placebo treatment. The study is designed to prevent long-term pain outcomes following surgery and improve patient quality of life. Participants are randomly assigned to receive either an intravenous lidocaine infusion or a placebo saline infusion during surgery. The lidocaine group receives a 1.5 mgkg bolus at the start of anesthesia, followed by a 2.0 mgkghour infusion until surgery ends and up to 30 minutes into recovery. The placebo group receives a matching saline infusion under the same conditions. Study medications are blinded and prepared in syringes to ensure unbiased treatment. Patients are monitored closely during surgery and recovery. After surgery, participants are followed up during the first three days and then at three and twelve months to assess their pain levels, use of pain medication, physical and emotional functioning, and overall quality of life. Researchers also monitor for neuropathic pain, cancer recurrence, adverse events, and cost effectiveness of the intervention. These assessments help measure the impact of lidocaine on preventing persistent pain and improving recovery over the year following surgery.