Clinical Research Directory

Comparison of Analgesic Efficacy of Intrathecal Bupivacaine Versus Bupivacaine Plus Dexmedetomidine in Patients Undergoing Orthopedic Surgeries.

Clinical Trial Overview: Intrathecal Bupivacaine vs. Bupivacaine + Dexmedetomidine Primary Objective Duration of Analgesia:\*\* To compare the mean duration of postoperative pain relief between hyperbaric bupivacaine alone versus bupivacaine combined with dexmedetomidine in adults undergoing elective lower-limb orthopedic surgeries. Secondary Objectives Block Characteristics:\*\* Compare the exact onset and duration of both sensory and motor blockade. Safety Profile:\*\* Monitor and compare hemodynamic stability, focusing on side effects like hypotension (low blood pressure) and bradycardia (low heart rate). Study Design \& Framework Design:\*\* Prospective, randomized, double-blind, parallel-group controlled clinical trial. Setting:\*\* SKBZ-AK CMH, Muzaffarabad, Azad Kashmir. Sample Size:\*\* Total of 80 patients divided into two equal groups (Group B = 40, Group BD = 40) using consecutive sampling. Intervention \& Protocol Breakdown Patients will be randomly and blindly assigned to one of two distinct groups, receiving a single intrathecal (spinal) injection: * Group \| Local Anesthetic Component \| Adjuvant / Control Component \| * \--- \| --- \| --- \| * \*\*Group B (Control)\*\* \| 15 mg of 0.5% Hyperbaric Bupivacaine \| 0.5 mL Normal Saline \| * \*\*Group BD (Study)\*\* \| 15 mg of 0.5% Hyperbaric Bupivacaine \| 10 µg Dexmedetomidine \| Participant Journey \& Data Collection To maintain strict data integrity and satisfy the protocol requirements, enrolled patients will undergo a structured timeline from screening to a 24-hour postoperative monitoring phase: Screening \& Consent:\*\* Pre-Anaesthesia Clinic. Recruit patients meeting strict criteria (Aged 18-60, ASA I/II, BMI 18.5-29.9 kg/m²) and obtain informed written consent while recording baseline characteristics. Randomized Drug Delivery:\*\* Intraoperative Phase. Administer the concealed study drug at the L3-L4 or L4-L5 space. Assess the immediate onset of sensory block at the T10 dermatome and monitor vital signs every 5 to 10 minutes. 3\. \*\*Postoperative Monitoring:\*\* First 24 Hours. Track regression of sensory and motor blocks using the Modified Bromage Scale. Log the exact time to first rescue analgesia request (triggered when pain score NRS is 4 or greater) and monitor for safety endpoints. \> \*\*Operational Target:\*\* The primary hypothesis hinges on a significant extension of the time window before the first rescue analgesia is requested. International data in obstetric fields suggests a profound extension, but this trial establishes direct clinical evidence for orthopedic lower-limb procedures.

Mindfulness in Fracture Recovery and Reduction of Opioid Reliance: Evaluating the Feasibility of Implementing a Brief, Mindfulness-based Intervention to Manage Pain and Anxiety Before and After Fracture Surgery

Breaking a bone is not only physically painful but also emotionally overwhelming. Patients often experience intense pain, anxiety, and uncertainty as they are rushed to hospital, undergo emergency treatment, and prepare for surgery. After surgery, many continue to struggle with pain and rely on opioid medications, which carry serious risks including addiction. In the context of our current opioid epidemic, it's critical that alternative treatment strategies are urgently evaluated. Mindfulness is a practice that helps people focus on the present and has been shown to reduce stress and pain in other settings. In this trial, patients with broken arms or legs who need surgery at Hamilton General Hospital will be randomly assigned to one of two groups who will listen to a two-part, audio recording before and after surgery. Those in the interventional group will engage in a 7-minute audio-guided mindfulness exercise before surgery to help reduce anxiety, and another 7-minute audio-guided mindfulness exercise after surgery to help manage pain. Those in the control group will listen to a 7-minute educational audio recording before surgery and again after surgery. The main goal is to see if this approach is practical-can enough patients be recruited, and will they complete the audio recordings? The study will also look at early signs of whether the intervention helps reduce pain, anxiety, and opioid use six weeks after surgery. If feasible, a larger study can be conducted to determine if these exercises can help patients manage pain and reduce their need for opioids after surgery. If successful, this simple, low-cost approach could be widely used in hospitals to support recovery and reduce reliance on pain medications.

The Influence of Perioperative Strategies on the Extent of in Orthopaedic Prosthetic Surgery

To assess the extent of blood loss in prosthetic surgery, considering whether possible variables may influence, either positively or negatively, the extent of such loss. The assessment will be carried out by analysing parameters (haemoglobin - haematocrit) in the immediate preoperative period and then on days 1-3 and 7. Numerous clinical studies have examined blood loss - both intraoperative and, above all, total blood loss - in shoulder, hip and knee replacement surgery. Anaesthetic and surgical techniques, relevant medications, the use of pneumatic tourniquets and, more simply, intraoperative positioning, as well as blood-sparing and blood recovery methods, have been the subject of extensive literature. Our study aims to retrospectively evaluate a full year of prosthetic surgery, analysing all the factors involved in the search for a definitive answer regarding the best method for this purpose, if feasible \[1,2,3,4,5\]. Prior to admission, the patient undergoes a standardised series of tests, which also include a complete blood count, serum iron, transferrin and ferritin levels. This series of tests concerning haematocrit and haematopoietic function is then repeated on the 1st, 3rd and 7th post-operative days to assess overall blood loss . Patients of both sexes who have undergone total knee replacement (unilateral or bilateral), unicompartmental and total knee replacement (unilateral or bilateral), and total shoulder replacement. The above patients operated on between January 2025 and December 2025 at the San Siro Clinic.

Effect of Liposomal Bupivacaine on Rebound Pain After Peripheral Nerve Block in Orthopedic Surgery.

This study will prospectively compare the preventive effect of liposomal bupivacaine combined with plain bupivacaine versus plain bupivacaine alone on rebound pain after nerve block in patients undergoing orthopedic extremity surgery. The primary aim is to assess whether the combination reduces the incidence or severity of rebound pain (i.e., more effectively covers the postoperative inflammatory peak on days 2-3 and provides a smoother regression curve of sensory blockade). Secondary aims include evaluation of upper limb functional scores, occurrence of chronic pain, and health-related quality of life. All aims will be assessed over 72 hours or the duration of hospitalization if shorter.

Ligamentum Teres in Management of Developmental Hip Dysplasia

Treatment of developmental dysplasia of the hip (DDH) is still challenging, till now there is no any recent advances have refined our understanding of how best to survey for the condition during infancy and refine the selection of patients who can best benefit from hip preservation surgery.