Clinical Research Directory

Superficial vs Deep Serratus Anterior Plane Block for Analgesia After Mammoplasty

The serratus anterior plane block (SAPB) is an ultrasound-guided fascial plane block used for perioperative analgesia in thoracic and breast surgeries. This technique involves the injection of local anesthetic into either the superficial or deep interfascial plane around the serratus anterior muscle at the mid-axillary line, targeting the lateral cutaneous branches of the intercostal nerves and providing analgesia to the anterolateral thoracic wall. The present prospective, comparative, single-blind clinical study aims to compare the postoperative analgesic efficacy of superficial and deep SAPB techniques in patients undergoing mammoplasty surgery. The primary objective is to evaluate total opioid consumption within the first 24 hours postoperatively,while secondary outcomes include postoperative pain scores,additional analgesic requirements, postoperative nausea and vomiting, patient satisfaction, time to first mobilization, and vital signs within the first 24 hours postoperatively. The results of this study may help determine the more effective SAPB technique for improving postoperative pain control and reducing opioid use in patients undergoing mammoplasty.

Perioperative Analgesic Effects of PENG Versus PENG Plus LFCN Block in Hip Surgeries

This study is designed to find the best way to control pain after hip surgery performed through a side (lateral) incision. Two different types of nerve blocks used before the operation will be compared. In one group, patients will receive a Pericapsular Nerve Group (PENG) block, which numbs the main nerves that carry pain signals from the hip joint. In the other group, patients will receive a PENG block together with a Lateral Femoral Cutaneous Nerve (LFCN) block, which adds extra pain relief for the skin and outer part of the thigh. A total of 72 patients between 18 and 80 years old will take part in this study. All operations will be done under spinal anesthesia. Pain levels will be measured several times during the first 24 hours after surgery using a simple 0-10 pain scale. Patients will receive pain medicine through a pump that allows them to press a button when they feel pain. The total amount of medicine used will be recorded. The researchers will also monitor when patients first need pain medicine, when they can start walking, how satisfied they are with pain control, and if they experience side effects such as nausea or dizziness. By comparing the two methods, the study aims to see whether adding the LFCN block to the PENG block provides better pain control, lower drug use, faster recovery, and higher patient comfort after hip surgery.

Bupivacaine Liposomes or Bupivacaine for CMB on Postoperative Analgesia in Laparoscopic Hepatobiliary Pancreatic Surgery

Numerous studies have confirmed that regional analgesia using peripheral nerve block has great potential for perioperative analgesia in abdominal surgery. Ultrasound guided costal margin block (CMB) is a new regional anesthesia technique that has been proven to compensate for the analgesic effects of regional analgesia techniques such as transverse abdominal muscle plane (TAP) and rectus abdominis sheath (RSB) on mid abdominal incisions, but it is difficult to meet the analgesic needs of anterior and outer abdominal wall incisions. According to relevant anatomy and research, the application of local anesthetics along the rib margin under the rectus abdominis muscle or under the external oblique muscle on the rib surface can block the lateral and anterior cutaneous branches of the thoracoabdominal nerve, known as CMB. Ultrasound guided CMB requires the injection of local anesthetics onto the surface of the rib along the plane below the rectus abdominis and oblique muscles, covering most of the upper abdominal incision pain. However, there are few reports on other types of upper abdominal surgeries such as liver, gallbladder, and pancreas surgeries. Bupivacaine liposomes are an important innovation, which encapsulate bupivacaine in polycystic liposomes using DepoFoam technology to achieve slow drug release and effectively prolong pain relief time by up to 72 hours. This ultra long acting local anesthetic has significant advantages in reducing opioid use, improving analgesic satisfaction, reducing complications, and shortening hospital stays, and has been applied in the ERAS concept. The investigators designed a prospective, single blind, randomized, active controlled clinical trial to investigate the effect of bupivacaine liposomes in combination with bupivacaine mixture or bupivacaine alone for ultrasound-guided bilateral CMB on postoperative analgesia in patients undergoing laparoscopic hepatobiliary pancreatic surgery. Our main hypothesis is that the use of bupivacaine liposomes and a mixture of bupivacaine for ultrasound-guided CMB in a multimodal analgesia regimen can more effectively reduce the dosage of intravenous patient-controlled analgesia (PCA) opiates within 72 hours after laparoscopic hepatobiliary pancreatic surgery compared to using bupivacaine alone. Secondary outcomes include the dosage of PCA opiates within 24-48 hours, pain score values, patient satisfaction, adverse reactions, and complications.

Effectiveness of Low Volume Versus High Volume of Local Anesthetic in Ultrasound Guided Combined Supraclavicular and Interscalene Block for Upper Limb Surgery

The aim of this study is to evaluate the effectiveness of low versus high volumes of local anesthetic in ultrasound-guided combined supraclavicular block (SCB) and interscalene block (ISB) for upper limb surgery. This randomized, controlled trial will assess the analgesic effectiveness of low-volume local anesthetic in these blocks. We hypothesize that a low volume will provide similar analgesic effects to a high volume, with fewer complications. The study will involve 40 adult ASA I and ASA II patients undergoing upper limb surgery, divided into two groups: Group A (low volume) and Group B (high volume). The primary outcome will compare intraoperative and postoperative analgesic effects of different volumes. The secondary outcome will evaluate complications related to local anesthetics (toxicity) and injection techniques (e.g., phrenic nerve palsy, pneumothorax, hematoma).

Pain Management Protocol in Abdominal Surgeries in City of Erbil

Intervention Our study involves a novel multimodal pain management protocol for postoperative pain management. The protocol consists of 4 main phases: preoperative, intraoperative, postoperative, and post-discharge phases with different pain management strategies. Each phase is designed to work synergistically with the subsequent phases to optimize pain control and minimize opioid use. All interventions will be administered by trained healthcare professionals and will be tailored to individual patient needs and responses. The protocol will be continuously monitored and adjusted as necessary to ensure optimal pain management while minimizing potential side effects and opioid use. Preoperative phase The preoperative phase focuses on patient education with the aim of educating patients on pain expectations, management strategies, and the recovery process. This is exclusively comprised of educational sessions delivered to each included patient. The sessions are designed to interactively explain the surgical procedure, expected pain levels, and available pain management options using multimedia resources such as videos and brochures. Well-trained pain management specialists will conduct the sessions, and pre-post quizzes will be carried out to ensure optimal patient understanding. Additionally, during this phase, patients will be educated on how to report their perceived pain, rated from 0 to 10 on the visual analog scale (VAS). Subsequently, another dedicated pain-management specialist will engage with each patient to formulate and document an individualized pain management plan, taking into consideration the patient's medical history, previous pain experiences, and preferences for pain management strategies. As part of preemptive analgesia, patients receive 300 mg of gabapentin orally 2 hours prior to surgery, unless contraindicated. 4.2. Intraoperative phase At this phase, our main objective is to utilize effective anesthetic strategies that minimize postoperative pain and accelerate recovery. We will utilize the current standardized protocol, including premedication with midazolam (0.02-0.04 mg/kg IV), induction with propofol (1.5-2.5 mg/kg IV), and maintenance of anesthesia using isoflurane or sevoflurane (0.5-1.5 MAC). When appropriate, patients will also receive ultrasound-guided regional nerve blocks relevant to the surgical site, performed by a trained anesthesiologist, to enhance postoperative pain control. 4.3. Postoperative management Postoperatively, our multimodal management plan aims to maximize pain management, minimize opioid use, and enhance patient recovery. This phase includes complementary both non-pharmacologic and pharmacologic interventions. In particular, non-pharmacologic measures will include physical therapy, cognitive behavioral therapy (CBT), and transcutaneous electrical nerve stimulation (TENS). Pharmacologic intervention in this phase will include optimized use of NSAIDs, tramadol, adjuvant analgesics, and skeletal muscle relaxants in patient-centered, tailored plans that minimize opioid consumption. For the non-pharmacologic part, early mobilization and physical therapy will start on postoperative day 1, with patients engaging in physical activities supervised by a physical therapist. This step will focus on promoting circulation, maintaining muscle strength, and gradually increasing mobility. CBT sessions, conducted by a trained psychologist, will be offered to patients either individually or in groups. These sessions will concentrate on developing pain-coping strategies and stress-reduction techniques. Additionally, transcutaneous electrical nerve stimulation (TENS) units will be made available for patient use as needed, with proper instruction on application and usage provided by nursing staff.

Guiding Opioid Administration by Nociception Level Index (NOL) in Patients With Regional Anesthesia

General anesthesia consists of a combination of hypnotic drugs to achieve unconsciousness and opioid analgesics to ensure antinociception. An alternative approach to the intraoperative administration of high-potency opioids to achieve antinociception during surgery is combining general anesthesia with regional anesthesia. Modern general anesthesia aims to avoid an overdose of opioid analgesics and reduce side effects of opioid administration. Quality and safety of general anesthesia are of major clinical importance and can be improved by adjusting the opioid analgesics to the optimal individual dose needed. In current clinical practice, opioid dosage is usually determined by clinical judgment. However, different monitoring devices estimating the effect of nociception during unconsciousness have become commercially available. One of the most recent commercially available nociception indices is the Nociception Level Index (NOL). Until today, there is conflicting evidence on whether guiding sufentanil administration by NOL monitoring, which is the intended use of the nociception index, affects postoperative pain level in the postanesthesia care unit (PACU), the amount of postoperatively administered opioids, and the quality of postoperative recovery in patients with a combination of general and regional anesthesia. This study aims to investigate the clinical performance of intraoperative NOL monitoring and determine whether guiding sufentanil administration by NOL monitoring - compared to routine care - reduces either postoperative pain level in the PACU, postoperative opioid consumption in the PACU or postoperative opioid consumption in the first 24 hours after the operation in patients having trauma and orthopedic surgery with combined general and regional anesthesia.

Intrathecal Morphine Versus Epidural Analgesia for Open Colon Surgery

Effective pain management after abdominal surgery is essential for recovery. This study compares two pain relief methods-intrathecal morphine (a single spinal injection) and continuous epidural analgesia-for patients undergoing open colorectal cancer surgery. The investigators expect intrathecal morphine to provide equal pain relief at rest 24 hours after surgery, while epidural analgesia may be more effective during movement. By 48 to 72 hours, both methods should offer similar pain control. The epidural group may require fewer additional pain medications but could experience more side effects, including a higher risk of low blood pressure and technical difficulties. Additionally, these patients may have a slightly longer hospital stay. In contrast, the intrathecal morphine group may have fewer overall side effects. Despite these differences, patient satisfaction, sleep quality, and recovery are expected to be similar in both groups. By evaluating these methods, this study aims to determine the most effective and safe approach to post-surgical pain management, improving comfort and recovery outcomes for patients.

Comparison Between Ultrasound Guided Erector Spinae Plane Block and Dexmedotomidine in Lumber Spine Surgeries.

Ultrasound (US) guided Erector spinae plane block (ESPB) as a new trunchal fascial plane block technique was proposed in 2016. US guided ESPB has aroused the interest of many nerve block experts. The goal of this study is to evaluate the effect of US guided ESPB versus (VS) intravenous Dexmedotomidine on postoperative analgesia and intra operative hemodynamic parameters in lumbar spine surgeries. The aim of this study is to compare the efficacy of ESPB to intravenous Dexmedetomidine in patients who are undergoing elective lumber spine surgeries regarding the effect on postoperative analgesia and intra operative hemodynamic parameters.

Comparison Between Fentanyl and Dexmedetomidine As Adjuvant to Bupivacaine in Combined IPACK and Adductor Canal Block for Postoperative Analgesia After Knee Surgeries

This study will be undertaken to compare the analgesic effects of of fentanyl versus dexmedetomidine as adjuvant to bupivacaine in combined IPACK and ACB for pain management after total knee arthroplasty.

Ultrasound Guided Paravertebral Block Versus Erector Spinae Block for Postoperative Analgesia After Inguinal Hernia Repair in Pediatric Patients

The aim of the study is to compare postoperative analgesia in pediatric patients undergoing inguinal hernia repair by comparing the efficacy of ultrasound guided paravertebral block versus ultrasound guided erector spinae plane block.

Evaluating the Analgesic Efficacy of Oxycodone Hydrochloride in Pediatric Laparoscopic Cryptorchidism Surgery

Cryptorchidism surgery is a common pediatric procedure, often performed laparoscopically to reposition undescended testes into the scrotum. This technique involves manipulation and traction of the spermatic cord, which can lead to emergence agitation and short-term postoperative pain. Managing these symptoms effectively is essential for enhancing perioperative comfort and supporting faster recovery in children. Oxycodone hydrochloride, a newer opioid with established analgesic effects in adult surgery, has been less studied in pediatric contexts. This randomized controlled trial aims to evaluate the effects of administering 0.1 mg/kg oxycodone hydrochloride 30 minutes before the end of laparoscopic cryptorchidism surgery in children aged 1 to 6. The study will assess outcomes such as anesthesia emergence time, extubation time, incidence of emergence agitation, postoperative analgesia, and nausea and vomiting. The goal is to determine if oxycodone hydrochloride could be an effective choice for pain relief in pediatric laparoscopic surgery, potentially reducing pain and complications, and providing clinical evidence to optimize anesthesia management for safer and more satisfactory pediatric surgical care. This research aspires to contribute to the guidelines for pediatric anesthesia, offering a scientific basis for the clinical application of oxycodone hydrochloride in children.

Erector Spinae Plane Block with Dexmedetomidine and Bupivacain Versus Dexamethasone and Bupivacain for Postoperative Analgesia in Patients Undergoing Abdominal Surgeries

To compare the analgesic effect of dexmedetomidine combined with bupivacaine versus dexamethasone combined with bupivacaine for ultrasound-guided ESPB for postoperative pain control in patients scheduled for abdominal surgeries