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.

Early Outcome of Simultaneous Bilateral Total Knee Replacement With and Without Tourniquet

This randomized controlled trial compared early outcomes after replacement of both knees during the same operation, with and without tourniquet use. A tourniquet was an inflatable cuff placed around the upper thigh and tightened during surgery to temporarily restrict blood flow. The study tested the hypothesis that tourniquet use would reduce blood loss during and after surgery, preserve hemoglobin levels, and reduce early postoperative pain. Hemoglobin was the protein in red blood cells that carried oxygen. The study was designed to include 84 patients aged 40-80 years at the Department of Orthopedic Surgery, Shifa International Hospital, Islamabad. Patients were randomly assigned to two equal groups of 42. One group underwent replacement of both knees with tourniquet use, while the other underwent the same procedure without tourniquet inflation. Both groups received standardized surgical care, pain management, blood clot prevention, and rehabilitation. The outcomes assessed were blood loss during surgery, blood collected through drains from both knees during the first 24 hours after surgery, hemoglobin levels at 24 hours, and the decrease from preoperative hemoglobin levels. Pain in each knee was assessed at 24 and 48 hours using a scale from 0, indicating no pain, to 10, indicating the worst possible pain. These measurements were compared between the two groups to assess the effect of tourniquet use on early recovery.

VibraCool Device to Reduce Pain and Opioid Use After Anterior Cruciate Ligament Reconstruction (ACLR)

The goal of this project is to test the effects of the VibraCool mechanical stimulation neuromodulatory therapeutic device on post-operative pain and opioid use following anterior crucitate ligament reconstruction (ACLR), and thus residual opioids in circulation.

Oral Methadone in Cardiac Surgery

The purpose of this study is to compare the effects of administration of oral methadone preoperatively and intravenous methadone upon induction of general anesthesia on postoperative pain for patients undergoing elective cardiac surgery.

GENIVS Block Versus Adductor Canal Block After Total Knee Arthroplasty

The goal of this clinical trial is to learn whether the ultrasound-guided GENIVS block is not worse than (non-inferior to) the adductor canal block in reducing opioid use after total knee arthroplasty performed under spinal anesthesia. The main question it aims to answer is: \- Is total opioid consumption (intravenous tramadol, mg) in the first 24 hours after surgery with the GENIVS block not clinically worse than with the adductor canal block? Researchers will also compare pain scores, time to the first analgesic request, the need for rescue pain medication, mobilization (Timed Up and Go test and stair climbing), quality of recovery (QoR-15) and opioid-related side effects between the two groups. Participants will: * have elective, primary, one-sided knee replacement surgery under spinal anesthesia; * be randomly assigned to receive either a GENIVS block or an adductor canal block, with the same local anesthetic dose, at the end of surgery; * use an intravenous tramadol patient-controlled analgesia pump and receive standard pain treatment for 72 hours; * rate their pain and complete mobility tests and questionnaires at scheduled times during the first 72 hours after surgery.

Pain Relief After Trapeziectomy: Ibuprofen & Acetaminophen Versus Oxycodone

In the US, pain management after surgery for surgical treatment of osteoarthritis at the base of the thumb typically consists of prescription opioids during the early recovery phase. Given the highly addictive nature of prescription opioids, guidelines are being evaluated by hand surgeons to reduce opioid use while still maintaining pain control after surgery. A promising approach is to use non-narcotic medication as the first line of treatment. The purpose of this study is to demonstrate the efficacy of a combination of non-steroidal anti-inflammatory drugs (NSAIDs), ibuprofen and acetaminophen, in comparison to a morphine analogue substance (oxycodone) for pain management in the first 30 days after surgery.

Dance Study for Post-surgical Pain in Breast Cancer Survivors

The purpose of this study is to examine how a 12-week, virtual dance program may improve pain and quality of life in participants with persistent post-surgical pain, or PPSP, following mastectomy or lumpectomy.

Intravenous Dexamethasone to Prolong Caudal Block Analgesia in Children Undergoing Hip Surgery

The goal of this clinical trial is to learn whether a single intravenous dose of dexamethasone prolongs postoperative analgesia after a caudal block in children aged 6 months to 9 years undergoing surgery for developmental dysplasia of the hip. The main question it aims to answer is: does intravenous dexamethasone (0.5 mg/kg) lengthen the time to first rescue analgesic compared with placebo? Researchers compared dexamethasone with normal saline (placebo). All children received general anesthesia and a caudal block with bupivacaine 0.25%, and pain was assessed with the CHEOPS score during the first 24 postoperative hours.

Magnesium as an Adjuvant Agent for Postoperative Pain

Participants are being asked to participate in this research study because they have elected to undergo periacetabular osteotomy (PAO). This research study is looking at if using IV magnesium during surgery can help to reduce pain after surgery.

Gabapentin to Reduce Opioid Use Postoperatively (GROUP) in Children

The primary objective of this study is to determine if the peri and post operative use of gabapentin in children reduces the need for narcotics after thoracic surgery. We hypothesize that patients who are given gabapentin will need fewer morphine equivalents postoperatively than those who were not given gabapentin

Posterior Pericapsular Deep-gluteal Block

The goal of this clinical trial is to determine whether adding a posterior pericapsular deep-gluteal (PPD) block to pericapsular nerve group (PENG) and lateral femoral cutaneous nerve (LFCN) blocks improves pain control after total hip arthroplasty. The main questions it aims to answer are: * Does adding a posterior pericapsular deep-gluteal block reduce clinically significant pain during movement in the early postoperative period? * Does adding this block reduce postoperative pain and opioid requirements? * Does adding this block improve functional recovery after surgery? Researchers will compare patients receiving PENG and LFCN blocks with patients receiving PENG and LFCN blocks plus a posterior pericapsular deep-gluteal block to determine whether blocking the posterior region of the hip provides additional pain relief. Participants will: * Receive ultrasound-guided nerve blocks before surgery according to their assigned study group. * Undergo total hip arthroplasty under spinal anesthesia. * Have their pain assessed at predefined times after surgery, including during movement. * Be evaluated for opioid requirements and functional recovery after surgery.

Intravenous Methadone in Perioperative Acute and Chronic Management in Chinese Adult Cardiac Surgical Patients

Despite modern day improvements in pain treatment and availability of different analgesic modalities, suboptimal postoperative pain control remains an issue in cardiac surgical patients. Poorly controlled acute postoperative pain is associated with adverse physiological outcomes that impair the recovery of cardiac surgical patients. It is associated with decreased patient satisfaction, delayed postoperative ambulation, and the development of chronic postsurgical pain (CPSP). Intravenous opioids such as fentanyl and morphine have been the mainstay of perioperative analgesia for cardiac surgery, either by intermittent boluses by healthcare staff or through a patient-controlled device (PCA). The primary problem with this mechanism of delivery is that significant fluctuations in serum opioid concentrations can occur, resulting in effects which range from inadequate analgesia to overdose and respiratory depression. In contrast to intermittent administration of short-acting opioids such as morphine and fentanyl, a single dose administration of methadone can be considered.

Intravenous Methadone for Sternotomy Pain Control in Cardiac Surgery

Background Postoperative pain is significant in cardiac surgical patients. Perioperative analgesia with intermittent administration of opioids can result in significant fluctuations in serum opioid concentrations. Methadone should provide a rapid onset and long-term pain relief upon a single intravenous dose at induction of anaesthesia, and may reduce chronic postsurgical pain (CPSP) in cardiac surgical patients. The feasibility of using intravenous methadone in Chinese cardiac surgical patients, and its effect on acute and chronic pain management after cardiac surgery will be evaluated. Methods A single-centre, prospective, randomized-controlled study. Adult cardiac surgical patients will be randomized to receive either methadone 0.2mg/kg (maximum dose 20mg) or equipotent dose of morphine at induction of anaesthesia. Patient-controlled analgesia morphine protocol, oral paracetamol and dihydrocodeine will be given for postoperative analgesia. Venous blood sampling for plasma methadone concentration will be obtained at regular intervals from study drug infusion to 96 hours after administration. The primary outcomes will be the recruitment and attrition rate, complications from methadone, and the perceived trial feasibility. Secondary outcomes include time weaned to spontaneous breathing trial, morphine consumption within 24 hours and 72 hours after surgery, time to first morphine rescue, postoperative pain score, patient satisfaction, length of stay in ICU and hospital. Side effects of opioids including sedation, nausea and vomiting, and time to first bowel opening will be recorded. CPSP will be assessed with DN4 questionnaire at 3 and 6 months after surgery.

A Study to Evaluate the Use of Topical Ocular BL1332 for the Management of Postoperative Ocular Pain Following Photorefractive Keratectomy

This is a multicenter, double-masked study to evaluate the use of Topical Ocular BL1332 for the management of post-operative pain after Photorefractive Keratectomy (PRK) surgery.

Dose Response Study of Dexmedetomidine in Orthopaedic Spine Surgery Patients

To study the multimodal protocol combining adjunct dexmedetomidine with oxycodone in intravenous patient-controlled analgesia bolus dosing and effects in patients scheduled for posterolateral lumbar spine fusion with bilateral transpedicular screw instrumentation.

Exploring the Effects of Transcutaneous Electrical Acupoint Stimulation Therapy on Patients After Video-Assisted Thoracoscopic Surgery

Thoracic surgery is known to be one of the most painful types of surgery. If acute postoperative pain is not properly managed, there is a high risk that it may develop into clinically significant chronic pain within six months after surgery, which can seriously affect quality of life. According to research on Enhanced Recovery After Surgery (ERAS), using multimodal pain management strategies can significantly reduce postoperative pain and decrease reliance on pain medications. This study aims to investigate whether combining transcutaneous Electrical Nerve Stimulation therapy with conventional pain management can further enhance pain relief and improve recovery outcomes.

Scheduled or as Needed Pain Regimen?

The aim of this study is to determine feasibility of a randomized controlled trial and estimates of efficacy for pain control of a scheduled pain regimen versus an as needed pain regimen for participants undergoing same day surgery procedures.

Effectiveness of Ultrasound-guided Scalp Block for Supratentorial Craniotomy

Pain management in patients undergoing neurosurgery is a very important issue. The effectiveness of USG-guided scalp blocks for pain management in craniotomy surgery is currently not known. The purpose of this clinical trial is to evaluate the effectiveness of ultrasound-guided scalp block when performed in patients who undergo supratentorial craniotomies.

Biofeedback Based Virtual Reality Intervention to Manage Postoperative Pain

To develop and refine a technology based treatment protocol for preoperative education and training and postoperative care in children and adolescents undergoing surgery.

Bupivacaine-Lidocaine vs Bupivacaine for Ultrasound-Guided Popliteal Sciatic Nerve Block

This prospective, randomized, double-blind clinical trial aims to compare the efficacy of two local anesthetic regimens for ultrasound-guided popliteal sciatic nerve block in adult patients undergoing elective distal lower extremity surgery. Eligible participants (ages 18-65, ASA physical status I-III, BMI 18-35 kg/m²) will be randomized into two equal groups of 30. Patients in Group BL will receive a combination of 10 mL 2% lidocaine and 10 mL 0.5% bupivacaine, while patients in Group B will receive 20 mL 0.5% bupivacaine alone, administered via ultrasound-guided popliteal sciatic nerve block prior to surgery. The primary outcome is the onset time of sensory and motor blockade. Secondary outcomes include block success rate, duration of sensory and motor block, postoperative opioid consumption, pain scores assessed by the Numeric Rating Scale (NRS) at 2, 4, 8, 12, and 24 hours postoperatively, Quality of Recovery-15 (QoR-15) score, and incidence of rebound pain. The study is conducted at Ataturk University Research Hospital, Department of Anesthesiology and Reanimation, Erzurum, Turkey.

Low-Volume Pericapsular Nerve Group (PENG) Block With Dexamethasone vs Standard-Volume PENG Block After Total Hip Arthroplasty

The goal of this clinical trial is to compare two regimens of the pericapsular nerve group (PENG) block, an ultrasound-guided injection of local anaesthetic targeting the nerves supplying the front of the hip joint, for postoperative pain relief and quadriceps muscle function in patients undergoing primary unilateral total hip arthroplasty under spinal anaesthesia. The PENG block was originally proposed as a motor-sparing technique. However, the standard 20 mL volume can spread to the femoral nerve and cause quadriceps weakness. Reducing the injected volume may limit this spread and better preserve quadriceps strength, but smaller volumes risk shorter analgesic duration. Adding dexamethasone to a low-volume injection may compensate for the reduced volume. The main questions this trial aims to answer are: * Does a low-volume PENG block (10 mL bupivacaine 0.25%) with 4 mg dexamethasone differ from a standard-volume PENG block (20 mL bupivacaine 0.25%) in the time to first rescue analgesia? * Does it differ in the incidence and severity of quadriceps weakness on the operated side? Researchers will compare: * Group A (standard-volume PENG block): 20 mL bupivacaine 0.25%. * Group B (low-volume PENG block with dexamethasone): 5 mL bupivacaine 0.5% plus 4 mL normal saline plus 4 mg dexamethasone in 1 mL, giving 10 mL of bupivacaine 0.25%. Participants will: * Receive spinal anaesthesia with heavy bupivacaine 0.5% and fentanyl. * Be randomly allocated to Group A or Group B using computer-generated random numbers. * Receive the PENG block under ultrasound guidance, performed by an anaesthesiologist expert in regional anaesthesia. * Receive intravenous paracetamol 1 g every 8 hours, with intravenous nalbuphine 5 mg as rescue analgesia when the pain score (NRS) is 4 or more. * Be assessed by an anaesthesiologist blinded to group allocation for pain scores at rest and on movement at 2, 6, 12 and 24 hours; quadriceps strength (MRC scale and straight leg raise) at 6, 12 and 24 hours compared with the preoperative baseline; total opioid consumption over the first 24 hours; and time to first ambulation within the first 24 hours. The primary outcome is the time from completion of the PENG block to the first administration of rescue analgesia, recorded over the first 24 hours postoperatively. The study will be conducted at Ain Shams University Hospitals (El Demerdash Hospital) and will include 60 patients (30 per group), aged 50 to 70 years, ASA physical status I or II.

Bupivacaine for Post-operative Pain in Mohs

Mohs micrographic surgery (MMS) is regarded as the gold standard for the treatment of high-risk nonmelanoma skin cancer (NMSC). Pain after MMS peaks on the day of surgery and slowly decreases thereafter. The most common post-operative analgesics include acetaminophen, ibuprofen and narcotics. Lidocaine is the most commonly used anesthetic in MMS, but bupivacaine has been shown in other surgical specialties to be an effective adjuvant to reduce post-operative pain and opioid use when injected locally in the immediate postoperative period. Bupivacaine has also been shown to reduce intra-operative pain during MMS. The investigators plan a single-blinded prospective, randomized, controlled trial to determine if post-operative wound infiltration of bupivacaine versus normal saline improves post-operative pain and decreases need for post-operative pain medications including both narcotic and nonnarcotic analgesics.

Glossopharyngeal Nerve Block in Pediatric Adenotonsillectomy Operations

Tonsilloadenoidectomy operations in pediatric patients cause local pain. Especially, in order to reduce the need for narcotic painkillers, to ensure patient compliance and well-being, and to provide better quality pain management regional pain prevention methods, which are included in the guidelines, are applied to these patients. One of these methods is glossopharyngeal nerve block. This block is the blocks that the investigators routinely apply to patients in different uses for the purpose of pain management before/after adenotonsillectomy operations in the clinic. The investigators plan to apply the glossopharyngeal nerve card that the investigators will make in different doses and follow the patient's pain and stomach volume after the surgery.

Transcranial Magnetic Stimulation for Chronic Neuropathic Pain

Chronic neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory nervous system. It is highly prevalent, debilitating, and challenging to treat. Current available treatments have low efficacy, high side effect burden, and are prone to misuse and dependence. Emerging evidence suggests that the transition from acute to chronic neuropathic pain is associated with reorganization of central brain circuits involved in pain processing. Repetitive transcranial magnetic stimulation (rTMS) is a promising alternative treatment that uses focused magnetic pulses to non-invasively modulate brain activity, a strategy that can potentially circumvent the adverse effects of available treatments for pain. RTMS is FDA-approved for the treatment of major depressive disorder, obsessive-compulsive disorder, and migraine, and has been shown to reduce pain scores when applied to the contralateral motor cortex (M1). However, available studies of rTMS for chronic neuropathic pain typically show variable and often short-lived benefits, and many aspects of optimal treatment remain unknown, including ideal rTMS stimulation parameters, duration of treatment, and relationship to the underlying pain etiology. Here the investigators propose to evaluate the efficacy of high frequency rTMS to M1, the region with most evidence of benefit in chronic neuropathic pain, and to use functional magnetic resonance imaging (fMRI) to identify alternative rTMS targets for participants that do not respond to stimulation at M1. The central aim is to evaluate the pain relieving efficacy of multi-session high-frequency M1 TMS for pain. In secondary exploratory analyses, the investigator propose to investigate patient characteristic that are predictive of responsive to M1 rTMS and identify viable alternative stimulation targets in non-responders to M1 rTMS.