Clinical Research Directory

Impact of Communication Delays on Anesthesia Response to Medical Emergencies and Ultrasound-Guided Regional Anesthesia

Hypotheses The investigators hypothesize that a communication delay of 80 seconds compared to no delay will be associated with longer procedural times and decreased quality during brachial plexus block scanning. Secondly, the communication delay will be associated with more errors in treatment and a delay of essential treatments in a medical emergency. Background The near future will see crewed missions in deep space. As the number of people travelling to space increases, so will the chances of traumatic injury and other medical emergencies. Given many changes to body systems in microgravity and the scarcity of equipment and personnel in space, treating medical emergencies is already very difficult. Because most pain medications interfere with cognition, and general anesthesia would be very risky in these conditions, regional anesthesia ('nerve blocks') has been suggested as a less risky alternative. However, nerve blocks are highly specialized skills and responding to medical emergencies in general requires extensive medical training, it is likely that astronauts will require guidance from earth-based physicians. As crews venture deeper into space, the ability of teams to communicate in real time with earth-based medical teams decreases. For missions to the moon, communication delays of 3 to 160 seconds in each direction are expected. In the event of a medical emergency, space crews may require consultation with ground teams. The investigators predict that this communication delay will impact task duration, create opportunities for miscommunication and potentially result in higher rates of complications. Objectives * Quantify the difference (communication delay versus no delay) in time to identify critical structures while scanning brachial plexus block sonoanatomy and time to essential treatment during a medical emergency. * Quantify the difference (communication delay versus no delay) in quality and ease of imaging while scanning brachial plexus block sonoanatomy. * Quantify the difference in completeness of emergency treatment using a composite measure (communication delay versus no delay). * Describe the challenges and solutions for team functioning and remote mentorship when a communication delay exists. Methods This is a within-subjects, mixed-methods, simulation-based randomized study. Regional anesthesia novices (medical students) and Canadian Armed Forces (CAF) medical technicians or CAF nurses will be recruited and given a 4-hour training session on the basics of brachial plexus blocks and their complications. Participants will be placed in teams of 3, participating in two simulation scenarios. Once the team enters the simulation space, they will be able to ask for assistance from a "remote" team of experts. Teams will be guided through identifying the sonoanatomy for brachial plexus blocks and responding to a complication from placing a peripheral nerve block. Every team will complete both the no communication delay and 80-second communication delay. Teams will be randomly assigned the order in which they perform each condition. Time to "block" (when the participant identifies where they would place the local anesthetic) and time to essential treatments during an emergency will be recorded. Participants will rate the ease of ultrasound image acquisition and ease of communication, while the expert team will rate the quality of the ultrasound images and the ease of communication. Quantitative outcomes will be analyzed using univariate statistics. After the scenario, teams will debrief the scenario with a focus on communication, safe identification of target nerves and their ability to respond to a complication. Transcriptions of the debriefing sessions will be analyzed for themes using qualitative analysis.

Artificial Intelligence vs. Automated Messaging for Continuous Regional Analgesia Follow-up

Effective postoperative analgesia is critical for patient recovery, satisfaction, and the reduction of hospital stay duration. Continuous peripheral nerve blocks (CPNB) via catheter placement represent a cornerstone in achieving these objectives. Traditionally, follow-up for these patients has relied on standardized telephone protocols conducted by trained personnel. Original previous research in 2024 demonstrated that an automated text-messaging platform was feasible and maintained high patient satisfaction, it resulted in a significantly higher rate of unscheduled patient-initiated inquiries (28.3% vs. 6.4%) compared to traditional phone calls, likely due to a lack of adaptive response capabilities. Objective: This study aims to evaluate an enhanced technological iteration of our follow-up platform. By integrating an Artificial Intelligence (AI) interface trained on specialized clinical protocols, the new system is designed to provide automated, personalized and adaptive recommendations to patients. Methods and Intervention: The study will compare the effectiveness of this AI-driven platform against the previous version of the non-adaptive automated messaging system. The primary outcome is to compare the number of patient-initiated inquiries (re-consultations). Secondary outcomes include patient satisfaction, adherence to the follow-up protocol, and response rates from postoperative days one through three. Impact: The investigators hypothesize that the integration of AI will optimize human resources and improve patient autonomy without compromising safety or satisfaction, ultimately providing a scalable model for postoperative regional analgesia monitoring.

Comparison of Caudal and Quadratus Lumborum Blocks With Pain Monitoring in Children

Study Type: Prospective, Randomized, Observational Clinical Study Primary Purpose: The primary objective of this study is to compare the analgesic efficacy of caudal block (CB) and quadratus lumborum block (QLB) in children undergoing lower abdominal surgery using objective pain monitoring methods. Key Questions Addressed: Does the quadratus lumborum block provide superior intraoperative and postoperative analgesia compared to the caudal block, as measured by the Pain Monitor (PAM) and the FLACC scale? Is the PAM monitor a reliable tool for objectively assessing nociception and pain in children who are unable to verbally express pain? Which regional anesthesia technique more effectively delays the time to first postoperative analgesic requirement and reduces total analgesic consumption? Which method is associated with higher parental satisfaction and fewer postoperative side effects, such as postoperative nausea and vomiting? Comparison Groups: Children receiving ultrasound-guided quadratus lumborum block will be compared with those receiving caudal block. Intervention Group: Bilateral quadratus lumborum block with 0.5 mL/kg of 0.25% bupivacaine. Active Comparator Group: Caudal block with 1 mL/kg of 0.125% bupivacaine. Participant Population: A total of 68 children, aged 2 months to 6 years, with ASA physical status I-II, scheduled for elective lower abdominal surgeries (e.g., inguinal hernia repair, orchiopexy, hydrocele). What Participants Will Do: Participants will receive the assigned regional block as part of standard anesthetic care. Observational data will be collected as follows: Intraoperative: Continuous nociception monitoring using the PAM device at predefined time points (during laryngeal mask airway insertion, block performance, surgical incision, 20 minutes after block performance, and extubation). Postoperative: Pain assessment using the FLACC scale at 1, 2, and 4 hours in the post-anesthesia care unit. Rescue analgesia (intravenous paracetamol) will be administered if the FLACC score is ≥4. Time to first analgesic administration and total analgesic consumption will be recorded. Additional outcomes include postoperative nausea and vomiting (PONV) scores, Steward recovery scores, and parental satisfaction scores assessed using the Pediatric Parental Satisfaction Scale (PPPS). Primary Outcome: Intraoperative PAM index scores. Secondary Outcomes: Postoperative FLACC scores, time to first analgesic requirement, total postoperative analgesic consumption, incidence and severity of PONV, Steward recovery scores, and parental satisfaction (PPPS) scores.

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.