Clinical Research Directory

Intertransverse Process Block Versus Erector Spinae Plane Block for Postoperative Analgesia After Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy (PCNL) is the preferred minimally invasive procedure for renal stones larger than 2 cm, staghorn calculi and complex stone burdens, but it is frequently associated with moderate-to-severe postoperative pain arising from the incision, renal capsular distension and visceral or stent-related sources. Truncal fascial plane blocks are a key component of opioid-sparing Enhanced Recovery After Surgery (ERAS) pathways. The erector spinae plane block (ESPB) has accrued supportive evidence in PCNL, whereas the intertransverse process block (ITPB) - whose injectate target, the retro-superior costotransverse ligament space, lies closer to the paravertebral space than the ESPB target - has not been directly compared with ESPB in any urological surgery. This is a single-centre, prospective, stratified block-randomised, triple-blind, parallel-group superiority trial. A total of 140 patients undergoing elective unilateral PCNL under general anaesthesia will be randomised 1:1 to receive either ultrasound-guided ITPB or ESPB at the T10-T11 level before induction of anaesthesia, each with 20 mL of 0.375% ropivacaine (75 mg). Both groups will receive an identical intravenous patient-controlled analgesia (PCA) regimen (sufentanil 200 ug in 100 mL, 2 ug/mL; 1 mL bolus, 15-min lockout, no background infusion) for 48 h, with intravenous flurbiprofen axetil 50 mg as rescue. The primary outcome is cumulative opioid consumption over the first 48 postoperative hours, expressed as oral morphine equivalents (OME), calculated as OME (mg) = total sufentanil consumption (ug) x 3. The key secondary outcome is the area under the curve (AUC) of resting pain numeric rating scale (NRS) scores from 0 to 48 h. The hypothesis is that ITPB is superior to ESPB (that is, lower 48-h OME), with an expected between-group difference of -12 mg OME.

Long-Term Risk of Kidney Stones in Living Kidney Donors

Using a population-based, matched, retrospective cohort approach, this study will evaluate the long-term risk of kidney stones among living kidney donors compared with matched healthy nondonors. Linked administrative health care databases from Ontario, Alberta, and British Columbia will be used and living kidney donors who donated between 1992 and 2024 will be identified and matched 1:10 to a carefully selected population of healthy nondonors based on baseline characteristics. The primary outcome is a surgical intervention for kidney stones (including shockwave lithotripsy, ureteroscopy or percutaneous nephrolithotomy). The secondary outcome is a hospital encounter with a kidney stone diagnosis.

Relief Efficacy of Lidocaine Versus Morphine for Acute Renal Colic in the Emergency Department

The opioid epidemic continues to be a major public health crisis in the United States. According to the Center for Disease Control, approximately 8 million Americans reported misusing prescription opioids in 2023, with over 5 million Americans reporting that they suffer from opioid use disorder. The United States government estimates that 105,000 people died from drug overdose in 2023, and approximately 80,000 of those deaths can be attributed to opioids (\~76%). In acknowledgement of the opioid crisis, we wish to contribute to ongoing efforts to reduce unnecessary and excessive opioid prescription. In 2012, researchers in Iran published a randomized controlled trial comparing intravenous (IV) lidocaine to IV morphine for acute renal colic, reporting that 90% patients responded "successfully" in the lidocaine group versus 70% in the morphine group. They also concluded that there was a statistically significant difference between pain scores between the two groups at all time points, favoring the lidocaine group. However, the study was conducted at a single emergency department in Tabriz, Iran, with a relatively homogenous patient population, and the researchers did not explicitly define their primary outcome variable for what constituted a "successful" response in the treatment groups. The investigators of this study aim to build upon this preliminary evidence by recruiting a more diverse population to improve generalizability and by predefining pain-reduction thresholds to allow for more meaningful comparison between the interventions.

Sodium Bicarbonate as an Alternative to Potassium Citrate for Kidney Stones

Kidney stones affect 1 in every 11 people in the US each year. In patients with kidney stones who are prescribed medications for stone management, only 30.2% are adherent to a medication regime and even fewer, only 13.4 % are adherent with citrate medications. Prescription potassium citrate can be expensive for many patients, leading to non-compliance. Sodium bicarbonate is a potential medication alternative that is cheaper and can potentially alkalinize the urine and/or decrease the risk of future kidney stones. However, efficacy of alternatives to potassium potassium citrate are not well studied. This study seeks to evaluate sodium bicarbonate and assess its ability to alkalinize urine in a cohort of patients with kidney stones and compare this to prescription potassium citrate.

The Use of AR / VR in Patients Presenting to the ED With Renal Colic

Utilization of VR / AR Calming as an adjunct to pharmacologic pain management for Renal Colic in Emergency Department Patients