Clinical Research Directory

Mini-dose Dexmedetomidine-Esketamine Infusion and Perioperative Sleep Quality

Sleep disturbances are prevalent in older patients with osteoarthrosis or fracture who are scheduled for knee or hip replacement surgery. The occurrence of sleep disturbances is associated with worse outcomes including increased risk of delirium and cardiac events, and worsened functional recovery. Dexmedetomidine is a highly selective α2-adrenergic agonist with sedative, anxiolytic, and analgesic properties. It exerts sedative effects via activating the endogenous sleep pathways and produces a state like non-rapid eye movement sleep, which is different from opioid- and benzodiazepine-induced sedation. Esketamine is a N-methyl-D-aspartic acid receptor antagonist and has been used as an anesthetic and analgesic. Recent studies showed that low-dose esketamine has anti-depressive and sleep-promoting effects. The investigators suppose that mini-dose dexmedetomidine-esketamine combined infusion at night can improve perioperative sleep quality in patients scheduled for knee or hip replacement surgery.

OPPOSED (anteriOr hiP arthroPlasty regiOnal aneSthEsia stuDy) Study

Main indications for total hip arthroplasty (THA) are degenerative osteoarthritis of the coxofemoral joint, osteonecrosis of the hip, congenital disorders such as dysplasia and inflammatory arthritis. More recently, surgery using the direct anterior approach is getting popularity: this method, in fact, granting a significant sparing of the hip muscles, is associated with favorable results compared to other techniques, such as a lower risk of dislocation, limitated damage to soft tissues with better recovery and early discharge. Patients undergoing this procedure may although experience moderate to severe postoperative pain in the first few hours (with peaks observed in the first 12 hours), as well as potential complications such as nausea and vomiting related to opioids use. It has been shown that adequate pain control influences early mobilization and rehabilitation, ensuring a quicker recovery. The role of regional anesthesia techniques has been established in almost all areas of orthopedic surgery, and in particularly in the management of postoperative pain following hip replacement surgery, but definitive data are missing with regard to direct anterior approach. Regional anesthesia consists of infiltrating local anesthetics in sites (fascial planes or nerves), in order to limit or even eliminate the use of traditional painkillers, with a significant reduction in the side effects. The aim of this study is to compare the impact of two techniques, the Suprainguinal Fascia Iliaca (SIFI) block and the lumbar Erector Spinae Plane (ESP) block, in managing postoperative pain in subjects undergoing total hip replacement surgery performed by direct anterior approach. The primary objective of the study is the incidence of residual femoral and obturator nerves block (knee extension and hip adduction according to ASIA score) 8 hours after surgery in the two treatment groups. Secondary objectives include: • Time elapsed between the end of surgery and the recovery of lower limb motility enough to allow the patient to mobilize independently; • Total opioid consumption (calculated as morphine equivalents) at 8, 24 and 48 hours after surgery; • Pain according to NRS (numerica rating scale) at 8, 24 and 48 hours after surgery; • Extent of sensory block of the three branches of the lumbar plexus (femoral, obturator, lateral femorocutaneuous nerves) at 8, 24 and 48 hours after surgery; • Timing of hospital discharge; • Incidence of chronic or persistent postoperative pain (at 30 and 90 days after surgery); • Any postoperative complication

Research on Multimodal Multi-objective Integrated Machine Algorithm for Hip Replacement Surgery

Purpose: The aim of this study is to develop the Holistic Predictive Multi-Tasking Platform for Clinical Data Analysis (HoPreM) to accurately predict perioperative events following hip replacement surgery by integrating various types of data, including demographic, surgical, medical history, and laboratory information. The events targeted for prediction include acute kidney injury (AKI), blood transfusion requirements, 48-hour postoperative discharge (48hPOD), Intensive Care Unit (ICU) transfer, and length of hospital stay (LOS). Key Questions: Can the HoPreM platform reduce the risk of complications after hip replacement surgery? How accurate is the platform in predicting the specified perioperative events? Participants: Participants will include patients undergoing hip replacement surgery, aged 18 and above, with less than 10% missing values in their medical records. The collected data will be used to train and test the predictive models of the HoPreM platform. Study Procedures: Patient data will be collected from Xi'an Honghui Hospital, including creatinine values recorded before and after surgery. The HoPreM platform will process multimodal data, including demographic, surgical, medical history, and laboratory test data. Various ensemble learning algorithms (including XGBoost, random forest, LightGBM, and CatBoost) will be applied to predict different perioperative outcomes. Expected Outcomes: The HoPreM platform is expected to demonstrate its capability in predicting complications after hip replacement surgery, particularly acute kidney injury and blood transfusion requirements. Through SHAP value analysis, the study aims to reveal relationships between features and clinical outcomes, enhancing the model's interpretability and clinical utility. Contact Information: For any questions about this study or for more information, please contact the research team.