Clinical Research Directory

Comparison Of Ultrasound Guided Transversus Abdominis Plane Block Versus Wound Infiltration With Local Anesthetics for Post Operative Analgesia

This randomized controlled trial compared two methods of pain relief after inguinal hernia repair: an ultrasound-guided transversus abdominis plane (TAP) block and local anesthetic injection around the surgical wound. The study tested the hypothesis that average pain scores differed between the two methods. The study was conducted in the Department of Anesthesia at King Edward Medical University/an affiliated hospital in Lahore. Eighty male patients aged 18-60 years who underwent planned inguinal hernia repair were included. Patients were randomly assigned by a lottery method to two groups of 40 patients each. One group received an ultrasound-guided TAP block, in which bupivacaine, a local anesthetic, was injected into a space between the abdominal muscle layers to numb the nerves supplying the surgical area. The other group received the same dose of bupivacaine injected into and around the wound margins. Both groups also received paracetamol and diclofenac for pain relief. The main outcome was the average pain score four hours after treatment. Pain was assessed using a visual analogue scale ranging from 0 to 10, where 0 represented no pain and 10 represented the worst pain. Further pain assessments continued for up to 24 hours after surgery, and patients were monitored for complications related to either procedure.

Pain Control and Recovery After Thoracic Surgery Using SPSIP Block

Thoracic surgery is frequently associated with significant postoperative pain, which may impair respiratory function, mobilization, recovery, and patient satisfaction. The Serratus Posterior Superior Intercostal Plane (SPSIP) block is a recently described ultrasound-guided fascial plane block that may provide effective analgesia after thoracic surgery. This prospective observational cohort study will evaluate the analgesic effectiveness and postoperative recovery associated with SPSIP block in adult patients undergoing elective minor video-assisted thoracoscopic surgery (VATS), major VATS, or thoracotomy. All patients will receive SPSIP block as part of routine institutional multimodal analgesia. The primary outcome will be postoperative quality of recovery assessed using the Quality of Recovery-15 (QoR-15) questionnaire at 24 hours after surgery. Secondary outcomes will include postoperative pain intensity, opioid consumption, rescue analgesic requirements, postoperative nausea and vomiting, pulmonary complications, patient satisfaction, length of hospital stay, and chronic postoperative pain.

Comparison of IV Dexmedetomidine Versus Clonidine Versus no Alpha 2 Agonist on Emergency Delirium, PACU Length of Stay and Time to Hospital Discharge in Children Undergoing (Adeno)Tonsillectomy: a Prospective Observational Study

Emergence delirium (ED) is a frequent complication in children undergoing general anesthesia, particularly following ENT procedures such as adenotonsillectomy. Alpha-2 adrenergic agonists, such as clonidine and dexmedetomidine, are commonly used in pediatric anesthesia for their sedative, analgesic, and ED-reducing properties.The purpose of this prospective observational study (CLONIDEX) is to evaluate and compare the occurrence of emergence delirium, Post-Anesthesia Care Unit (PACU) length of stay, and overall time to hospital discharge in pediatric patients undergoing (adeno)tonsillectomy with or without placement of myringotomy tubes who receive intravenous dexmedetomidine, intravenous clonidine, or no alpha-2 agonist as part of their standard anesthetic care.

Effects of Erector Spinae Plane Block on Opioid Consumption, Anesthetic Consumption and Hemodynamics in Lumbar Disc Herniation Surgeries.

Lumbar disc herniation (LDH) is an increasingly common spine disorder . In patients treated surgically, inhalation anesthesia and the use of opioids for analgesic purposes are generally the chosen anesthetic methods. Surgical techniques such as discectomy, microdiscectomy, and stabilization (REF) are used to treat LDH. Although discectomy is considered the primary option in the treatment of LDH, less invasive techniques such as microdiscectomy have been applied in recent years . However, despite the use of less invasive techniques, patients experience pain after surgery . Clinicians want to avoid complications such as thromboembolism and hemodynamic deterioration that may occur due to postoperative pain, and to apply effective pain treatment for patient comfort and rapid discharge from the hospital. It has also been stated that inadequate postoperative pain treatment may increase the risk of developing chronic pain. Therefore, the use of opioids for analgesic purposes in the intraoperative and postoperative periods is quite common. However, opioid use may cause side effects that negatively affect postoperative recovery and may delay discharge. Some of these situations include delayed recovery from anesthesia, failure to perform early postoperative neurological examination due to delayed recovery, postoperative nausea and vomiting (PONV), pruritus, urinary retention, respiratory depression, gastrointestinal dysfunction, and addiction. Another important issue is the difficulty of applying effective treatment to patients, the side effects that develop due to the applied treatments, and the increase in healthcare costs, which are important problems. Therefore, it is also very important to take a cost-effective approach while trying to treat patients at the highest level. The applied anesthesia and analgesia methods can also significantly affect the cost of surgical treatments. In particular, inhalation anesthetics used in patients receiving general anesthesia and opioids used for intraoperative and postoperative analgesia constitute a significant portion of the anesthesia cost. Therefore, strategies that will provide cost savings by reducing the use of both inhalation anesthetics and opioids are emphasized. In this context, nerve blocks or fascial plane blocks applied with local anesthetics come to the fore. With the widespread use of ultrasonography in regional anesthesia practice, regional plane blocks have also become widespread in parallel with this development and have begun to take more place in the literature. Erector spinae plane block (ESPB) is also among these blocks that are increasingly gaining ground in the literature. ESPB is a technique defined for both acute and chronic pain. ESPB is performed by administering local anesthetic (LA) to the fascial plane between the transverse process of the vertebra and the overlying erector spinae muscle. When literature data are examined, ESPB can be applied from the thoracic or lumbar levels in LDH surgery, before and after preoperative anesthesia induction, intraoperatively, at the end of surgery, before extubation or in the postoperative period. ESPB can be applied with the patient in the prone position, sitting or lateral decubitus position. In studies conducted on patients undergoing laparoscopic cholecystectomy, it was found that ESPB reduced the amount of intraoperative inhalation anesthetic and opioid consumption. In another study examining the effect of ESPB on lumbar spine surgeries, it was found that ESPB reduced the use of intraoperative fentanyl and isoflurane and significantly shortened the recovery time. In addition, ESPB is thought to provide more effective analgesia in postoperative pain management and reduce opioid consumption and opioid-related side effects after lumbar spine surgeries. According to the results of published studies, it has been stated that ESPB is more effective for postoperative analgesia in patients undergoing lumbar surgery, significantly reduces pain scores at rest (static) and during activity (dynamic), provides a significant decrease in 24-hour opioid consumption, prolongs the first analgesic requirement period and is associated with fewer side effects. Another important issue is to keep intraoperative hemodynamics stable within normal limits in patients under general anesthesia. Hemodynamic stability is very important to ensure that the amount of bleeding from the surgical site is kept at a minimum level, especially during LDH surgeries. It has been stated that the combined application of regional anesthesia and general anesthesia in spinal surgery provides better pain control as well as better hemodynamic stability. This study aimed to compare the effects of preoperative and intraoperative ESPB on opioid consumption, anesthetic drug consumption, and hemodynamics in LDH surgeries.

Relationship Between Fracture Type and Preoperative Nutritional Status With Postoperative Pain

The geriatric patient group is a population that should be considered differently than other age groups due to physiological characteristics that change with age. When literature data is examined, it is seen that patients over the age of 65 are evaluated differently in studies. The rapid aging of the general population causes more elderly patients to need surgery. However, malnutrition is a common comorbidity in surgical patients . In addition, chronic diseases, multiple drug addiction, low nutritional intake, decreased appetite and psychological conditions seen in geriatric patients are risk factors for the development of nutritional deficiencies . Therefore, it is important to specifically consider geriatric patients, who frequently have these risk factors, in terms of malnutrition and to evaluate the nutritional status of these patients before surgery. It is estimated that the prevalence of malnutrition in hospitalized geriatric patients varies between 30% and 60%, depending on the population studied and the assessment tools applied . Despite these high malnutrition rates, this issue has not received sufficient clinical attention. Furthermore, malnutrition is highly associated with the prognosis of elderly perioperative patients, which may lead to poor clinical outcomes, increased morbidity and mortality, complication rates, decreased quality of life, prolonged hospital stay, and increased hospital and healthcare costs. A number of different screening tools are currently available to assess nutritional status in the elderly. However, there is currently no gold standard. The Nutrition Risk Score 2002 (NRS2002) is a nutritional screening tool for adult inpatients, launched in 2002 by the European Society of Clinical Nutrition and Metabolism (ESPEN). The Mini Nutritional Assessment - Short Form (MNA-SF), recommended by the European Union, and the Geriatric Nutrition Risk Index (GNRI), which has recently been evaluated as a new screening tool, has been validated for the diagnosis of malnutrition and the prediction of clinical outcomes, and is based on objective measurements that do not require patient cooperation, and whose validity has been demonstrated in other studies for the prediction of short- and long-term outcomes. In addition, the Prognostic Nutrition Index (PNI) is an indicator used to assess the nutritional status of surgical patients, estimate the risk of surgery, and make prognostic judgments. Although it has been stated that all four nutritional screening tools mentioned above can be used as prognostic indicators in geriatric surgical patients, the relationship between these screening tools and postoperative pain, complications, and hospital stay in geriatric patients undergoing orthopedic hip surgery has not yet been evaluated. Hip fracture is a painful event that is frequently seen in older adults. Hip fractures are generally classified as femoral head fracture, femoral neck fracture, intertrochanteric fracture, and subtrochanteric fracture. Hip fracture is treated with proximal femoral nailing, partial hip replacement, and total hip replacement surgeries. Studies have reported that patients experience very high rates of moderate to severe pain following hip fracture surgery. This situation shows that the approach to pain management in hip surgery is still inadequate and that investigators need different perspectives on postoperative pain in these patients. It is known that hip fracture is associated with serious morbidity, mortality, and disability in the elderly. Inadequate pain management in these patients is associated with low motivation and has a high impact on functional recovery. Therefore, adequate pain management is important in patients with hip fractures to prevent mental and physical complications and to ensure appropriate compliance with rehabilitation. It is known that pain is affected by many factors such as biophysiological, biochemical, demographic, psychosocial, behavioral and moral variables and age. It is known that unmanaged postoperative pain will significantly affect cardiopulmonary and thromboembolic complications, morbidity and mortality, hospital discharge, quality of life and daily activities. In this context, determining the factors that predict acute pain will allow earlier intervention. Thus, short- and long-term morbidity, medication use, hospital stay and, accordingly, healthcare expenses will be reduced.This study aimed to evaluate the relationship between preoperative hip fracture type, surgery type, nutritional status and postoperative pain and prognosis (complications and hospital stay) in geriatric patients who will undergo hip surgery due to hip fracture. Secondly, it was aimed to determine which of the above-mentioned nutritional risk screening tools would be more appropriate in these patients and which nutritional risk screening tool could predict postoperative pain and prognosis in patients who will undergo hip surgery.

Ultrasound-Guided Pericapsular Nerve Group Block for Pain Control After Hip Surgery

This study evaluated whether an ultrasound-guided pericapsular nerve group (PENG) block could reduce pain and morphine use during the first 24 hours after hip surgery. A PENG block involves injecting a local anesthetic near nerves that carry pain signals from the hip. The study included 40 adults aged 20-80 years undergoing planned hip surgery under general anesthesia at Cumhuriyet University Hospital. Participants were randomly assigned to two groups of 20. Before surgery, one group received a PENG block with bupivacaine, a local anesthetic. The other group received an injection of normal saline in the same location as a placebo. Participants and the clinicians assessing postoperative outcomes did not know which injection had been given. After surgery, both groups received morphine through a patient-controlled pump. Pain scores, morphine consumption, the need for additional pain medication, and side effects including nausea, vomiting, and constipation were assessed over 24 hours.

US Guided EOI Block Versus ESPB for Postoperative Analgesia in Laparoscopic Cholecystectomy

To compare the efficacy of USG-guided bilateral External oblique intercostal (EOI) block with Erector spinae plane block (ESPB) for post-operative analgesia after laparoscopic cholecystectomy with a hypothesis that both External oblique intercostal fascial plane block and Erector spinae plane block are effective in providing post-operative analgesia.

Comparison of Ultrasound-Guided Erector Spinae Plane Block and Quadro-Iliac Plane Block in Elective Primary Unilateral Total Hip Arthroplasty

This prospective, single-center, randomized controlled, double-blind (participant and outcomes assessor) trial compares ultrasound-guided erector spinae plane block (ESPB) and quadro-iliac plane block (QIPB) in adult patients undergoing elective primary unilateral total hip arthroplasty (THA) under spinal anesthesia. Eighty patients will be randomized 1:1 to receive either block in addition to a standardized multimodal analgesia protocol. The primary outcome is cumulative opioid consumption (intravenous morphine equivalents, mg) during the first 24 postoperative hours. Secondary outcomes include quality of recovery (QoR-15), pain scores, opioid consumption at later time points, quadriceps strength, mobilization, patient satisfaction, and safety outcomes. It is hypothesized that QIPB will reduce 24-hour opioid consumption more than ESPB.

Effect of Intraoperative Tetracycline on Postoperative Pain After Mandibular Molar Extraction

Postoperative pain is a common complication following mandibular molar extraction and can negatively affect patient comfort and recovery. Tetracycline is a broad-spectrum antibiotic with anti-inflammatory properties that may reduce postoperative inflammation and pain when applied locally to the extraction socket. This randomized controlled trial aims to evaluate the effect of intraoperative placement of tetracycline on postoperative pain in patients undergoing surgical extraction of mandibular molars. A total of 74 eligible patients will be randomly assigned to receive either intrasocket tetracycline or no local medicament following tooth extraction. All participants will receive the same standard postoperative care and analgesic regimen. Postoperative pain will be assessed using the Visual Analog Scale (VAS) at 24 hours, 48 hours, and 7 days after surgery. The findings of this study will provide evidence regarding the effectiveness of local tetracycline in reducing postoperative pain and may help improve postoperative pain management following mandibular molar extraction.

Lumbar Erector Spinae Plane Block Versus PENG Block for Hip Fracture Surgery

The purpose of this clinical trial is to compare two different nerve block techniques-the Pericapsular Nerve Group (PENG) block and the Lumbar Erector Spinae Plane Block (L-ESPB)-for managing pain after hip fracture surgery in elderly patients. Hip fractures are common in older adults and often cause significant pain. Managing this pain effectively helps patients recover faster and move around sooner after surgery. Traditional pain relief options include nerve blocks and strong pain medications (opioids). However, opioids can cause unwanted side effects like nausea and drowsiness, while some traditional nerve blocks can weaken the leg muscles, making early walking difficult. Nerve blocks inject a local anesthetic (numbing medication) around specific nerves or within muscle layers to temporarily block pain signals: 1. PENG Block: Targets the specific sensory nerves supplying the front of the hip joint while minimizing leg muscle weakness. 2. Lumbar ESPB: Injects numbing medication near the lower spine to block pain signals coming from the hip region. Participants in this study will include adults aged 60 and older undergoing hip surgery for a femoral neck fracture under spinal anesthesia. Participants will be randomly assigned (like flipping a coin) to receive either the PENG block or the Lumbar ESPB before their surgery. Both blocks are performed under ultrasound guidance to ensure precise medication placement. Researchers will compare: * Pain levels at rest and during movement over the first 48 hours after surgery. * The total amount of additional pain medication (opioids) required. * Leg muscle (quadriceps) strength after surgery. * Any side effects or complications, as well as the overall length of hospital stay. The findings from this study will help doctors determine which nerve block provides better pain relief while preserving leg strength, aiding in safer and faster recovery for elderly patients after hip surgery.

Efficacy of Preventive Ketamine on Postoperative Pain

* Although bariatric surgery is mainly performed laparoscopically, analgesic optimization is still essential to reduce complications and to improve the patients' comfort. In laparoscopic sleeve gastrectomy, the intraoperative peritoneal instillation of bupivacaine hydrochloride (30 ml, 0.25%) was known to be safe and effective in reducing postoperative pain, nausea, and vomiting. * Furthermore, usage of ketamine both as a pre and post-operative pain management is well established. Ketamine can be used solely or in combination with other co-adjuvant drugs, increasing their efficacy. Many therapeutic properties of ketamine have been attributed to its antagonism mechanism to N-Methyl-D-aspartate receptors.

Anterior Nerves of the Knee Block Versus Femoral Nerve Block for Knee Arthroscopy

Knee arthroscopy is one of the most common orthopedic procedures, and effective postoperative analgesia is essential for early mobilization and patient comfort. Femoral nerve block provides effective analgesia after knee surgery but can cause quadriceps weakness. The anterior nerves of the knee (ANK) block is a recently described, motor-sparing fascial plane block targeting the sensory nerves of the anterior knee. This prospective, randomized, single-blind study compares ultrasound-guided ANK block with ultrasound-guided femoral nerve block in adult patients undergoing elective knee arthroscopy under spinal anesthesia, with respect to postoperative analgesic consumption, pain scores, intraoperative hemodynamics and time to first mobilization.

Post-Cesarean Caffeine: Pain and Recovery

This study Maims to assess bowel motility, pain and psychological well-being in women in the post-cesarean period by mobilizing them early and encouraging them to consume coffee.

The Impact Opioid Free Anesthesia on Postoperative Pain Intensity and Stress Response After Open Gynecology Surgery

This study compared impact of multimodal balancing anesthesia vs opioid free anesthesia on postoperative pain intensity and stress response after open gynecology surgery. Hypothesis was: opioid free anesthesia reduces postoperative pain intensity and stress response in terms of the value for pain in VAS (Visual Analog Scala) and for stress response in value of cortisol, prolactin and IL-6, CRP and improves postoperative patients subjective well-being and surgical outcome.

Effect of Bilateral Greater Occipital Nerve Block on Headache After Intracranial Aneurysm Coiling

Postoperative headache is a common complication following endovascular coil embolization of intracranial aneurysms and may increase analgesic requirements, impair patient comfort, and contribute to hemodynamic instability. The greater occipital nerve (GON) has anatomical and functional connections with the trigeminocervical complex, suggesting that greater occipital nerve blockade may modulate headache-related pain pathways. However, the effectiveness of prophylactic greater occipital nerve block in patients undergoing elective endovascular coiling of unruptured intracranial aneurysms remains uncertain. This prospective, randomized, sham-controlled, single-center clinical trial aims to investigate whether preoperative ultrasound-guided bilateral greater occipital nerve block reduces postoperative headache intensity during the first 24 hours following endovascular coil embolization. A total of 76 patients will be randomly allocated in a 1:1 ratio to receive either ultrasound-guided bilateral greater occipital nerve block with 0.25% bupivacaine or bilateral superficial sham injections with 0.9% normal saline. The active intervention will consist of 3 mL of 0.25% bupivacaine administered on each side in the fascial plane between the semispinalis capitis and obliquus capitis inferior muscles. The control intervention will consist of a superficial subcutaneous injection of 0.5 mL of 0.9% normal saline on each side. All participants will receive standardized general anesthesia and postoperative multimodal analgesia. The primary outcome will be the time-weighted average resting pain score during the first 24 postoperative hours, calculated from the area under the Numeric Rating Scale (NRS) pain score-time curve.

Comparison of TAP and QL Blocks for Postoperative Analgesia in Open Inguinal Hernia Repair

Background Postoperative pain management after open inguinal hernia repair remains a clinical challenge despite spinal anesthesia. Ultrasound-guided fascial plane blocks, such as Transversus Abdominis Plane (TAP) block and Quadratus Lumborum Block (QLB), have been increasingly used as part of multimodal analgesia. This study aimed to compare their effects on postoperative opioid consumption. Methods After ethics committee approval, 70 patients aged 18-65 years with ASA I-II undergoing elective unilateral inguinal hernia repair were included in this prospective, randomized study. Patients were allocated into two groups: Group Q (QLB) and Group T (TAP). Blocks were performed preoperatively under ultrasound guidance using the in-plane technique with 30 mL of 0.25% bupivacaine. Block success was defined as sensory blockade at T10-L1 dermatomes at 30 minutes. All patients received spinal anesthesia at the L3-L4 level with 12.5 mg of 0.5% isobaric bupivacaine. Postoperatively, patient-controlled analgesia (PCA) with tramadol was administered for 24 hours. Pain scores were assessed using the Numeric Rating Scale (NRS) at PACU and at 1, 3, 6, 12, 18, and 24 hours. Opioid consumption was recorded at 0-1, 2-12, 12-24 hours, and cumulatively over 24 hours. Postoperative side effects were also evaluated. Results Both QLB and TAP block provided effective postoperative analgesia. There were no significant differences between the groups in terms of total 24-hour opioid consumption or NRS pain scores at measured time points. However, QLB demonstrated a trend toward prolonged analgesic duration and wider dermatomal spread. Conclusion Both TAP and QLB are effective adjuncts to spinal anesthesia for postoperative analgesia in unilateral inguinal hernia repair. While QLB may offer broader and longer-lasting analgesia, its superiority over TAP block in reducing opioid consumption was not statistically significant.

ESP Versus SPSIP Block for Pain Relief After Shoulder Arthroscopy

This study will compare two regional anesthesia techniques for pain relief after arthroscopic shoulder surgery: high thoracic erector spinae plane (ESP) block and serratus posterior superior intercostal plane (SPSIP) block. Both techniques involve injecting a local anesthetic into tissue layers in the upper back under ultrasound guidance. The study will include 80 adults aged 18 to 75 years undergoing elective arthroscopic shoulder surgery at Bursa City Hospital. Participants will be randomly assigned to receive either an ESP block or an SPSIP block before general anesthesia. Participants and the clinician assessing postoperative outcomes will not know which block was assigned. All participants will receive a standardized pain management regimen, including a patient-controlled analgesia (PCA) pump that delivers tramadol when they press a button. Additional pain relief will be provided when needed. The main aim is to compare the total amount of tramadol delivered by the PCA pump during the first 24 hours after surgery. Other assessments will include pain at rest and during movement, quality of recovery at 24 hours, additional pain medication requirements, remifentanil use during surgery, and side effects or complications related to the blocks and opioid medications.

Sphenopalatine Ganglion Block in Maxillofacial Surgeries

Patients will be divided into 2 groups, 22 each. Group A will receive a sphenopalatine ganglion block via a gauze soaked in local anesthetic introduced in the 2 nostrils, then by local anesthetic injected by a cannula into both nostrils. Group B will undergo the same procedure, but normal saline will be used instead of the local anesthetic.

Lateral QL Block vs Intrathecal Morphine for Cesarean Section

Effective postoperative analgesia after cesarean delivery is essential for maternal recovery, early mobilization, breastfeeding, and maternal-infant bonding. Although intrathecal morphine (ITM) is considered the gold standard for post-cesarean analgesia, its use is associated with opioid-related adverse effects. Ultrasound-guided lateral quadratus lumborum block (QLB-I) has emerged as a promising alternative. This randomized, double-blind, non-inferiority trial aims to compare the postoperative analgesic efficacy of lateral QLB-I with ITM. Secondary outcomes include postoperative opioid consumption, pain scores, opioid-related adverse effects, quality of recovery (ObsQoR-11T), and maternal satisfaction.

Effects of Bolus Versus Infusion Ketamine During Laparoscopic Cholecystectomy

This prospective, randomized, controlled study evaluated the effects of different ketamine administration strategies in adult patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Participants were randomized into three groups: bolus ketamine, continuous ketamine infusion, or control without ketamine. The study investigated the effects of these strategies on optic nerve sheath diameter measured by ultrasonography as a surrogate marker of intracranial pressure, intraoperative sevoflurane consumption, and postoperative pain and analgesic requirements.

Ropivacaine Alone Versus Ropivacaine Plus Lidocaine With or Without Epinephrine for Supraclavicular Brachial Plexus Block in Upper Limb Orthopedic Surgery

This randomized controlled trial compared three local anesthetic solutions for ultrasound-guided supraclavicular brachial plexus block in adults aged 18 to 59 years undergoing upper limb orthopedic and trauma surgery at a general hospital of the Mexican Social Security Institute (IMSS) in Aguascalientes, Mexico. Participants were randomly assigned to receive 30 mL of ropivacaine 0.375% alone, ropivacaine 0.375% plus lidocaine 1%, or ropivacaine 0.375% plus lidocaine 1% with epinephrine. The main question was whether adding lidocaine, with or without epinephrine, to ropivacaine improves postoperative analgesia. Pain intensity (0 to 10 Numeric Rating Scale) at 6 hours after surgery was the primary outcome. Secondary outcomes were pain at 0 and 12 hours, need for rescue analgesia, analgesic and opioid consumption, motor block (modified Bromage scale) and adverse events during the first 12 postoperative hours. Block onset time was also recorded.

Aescin-Based Herbal Extract (Reparil) for Postoperative Sequelae After Mandibular Third Molar Surgery

This randomized, single-blind, controlled clinical trial aims to evaluate the efficacy and safety of Aescin-based herbal extract (Reparil®) compared with Ibuprofen in managing postoperative sequelae following surgical removal of impacted mandibular third molars. A total of 100 participants aged 18-40 years will be enrolled at the Dental Center, Medical City Hospital for Military and Security Services (MCMSS), Al Khoud, Oman. Participants will be randomly assigned to receive either Reparil® (Aescin 20 mg, three times daily for five days) or Ibuprofen (400 mg, three times daily for five days) following standardized third molar extraction procedures. Postoperative outcomes including pain (VAS), facial swelling (3D facial scanner), and mouth opening (digital caliper) will be assessed preoperatively, on day 2, and day 7 post-surgery. The study aims to determine whether Aescin offers comparable analgesic and anti-edematous effects to Ibuprofen with fewer adverse events.

Combined Popliteal and Adductor Canal Blocks for Postoperative Analgesia in Children With Cerebral Palsy

This prospective, randomized, controlled trial aims to evaluate the postoperative analgesic efficacy of combined ultrasound-guided popliteal sciatic nerve block and adductor canal block in children with cerebral palsy undergoing elective lower extremity surgery. Children aged 3-18 years with American Society of Anesthesiologists (ASA) physical status II-III will be randomized into two groups. Participants in the intervention group will receive combined popliteal sciatic nerve block and adductor canal block in addition to general anesthesia, whereas participants in the control group will receive general anesthesia with intravenous analgesia without peripheral nerve block. Postoperative pain will be assessed using the revised Face, Legs, Activity, Cry, Consolability (r-FLACC) scale at 1, 2, 6, 12, and 24 hours after surgery by an anesthesiologist blinded to group allocation.

Two Bupivacaine Concentrations for Recto-Intercostal Fascial Plane Block After Laparoscopic Cholecystectomy

Pain after laparoscopic cholecystectomy remains clinically relevant, and current recommendations favour multimodal, opioid-sparing analgesia including regional techniques. The recto-intercostal fascial plane block (RIFPB) is a recently described technique in which local anesthetic is injected into the plane between the rectus abdominis muscle and the 6th and 7th costal cartilages, targeting the anterior and lateral cutaneous branches of the sixth to ninth thoracic (T6-T9) thoracoabdominal nerves. In the investigators' previous randomized controlled trial, bilateral RIFPB after laparoscopic cholecystectomy significantly reduced the need for rescue analgesia (17.9% versus 55.3%) and pain scores during the first 12 postoperative hours. That trial used 30 mL of 0.25% bupivacaine per side (60 mL, 150 mg in total), a dose approaching the recommended upper limit, and whether lower doses provide comparable analgesia remains unknown. Because fascial plane blocks depend on local anesthetic spread, large volumes are preferred, increasing the total dose and the risk of local anesthetic systemic toxicity (LAST); lowering the concentration as volume increases has therefore been recommended. Equal-volume studies of transversus abdominis plane and erector spinae plane blocks suggest that lower concentrations provide comparable analgesia, but no study has compared concentrations for RIFPB. This trial will compare, at a fixed volume of 25 mL per side (50 mL in total), bilateral RIFPB with 0.25% bupivacaine (125 mg), bilateral RIFPB with 0.125% bupivacaine (62.5 mg), and routine port-site infiltration with 25 mL of 0.25% bupivacaine without a block (control) in adults undergoing elective laparoscopic cholecystectomy under general anesthesia. Ninety patients will be randomly allocated in a 1:1:1 ratio. The primary outcome is total rescue tramadol consumption during the first 24 postoperative hours. Secondary outcomes include numeric rating scale (NRS) pain scores at rest and on movement (coughing), the need for and time to first rescue analgesia, nausea, vomiting and pruritus, block-related complications and signs of LAST, patient satisfaction, and length of hospital stay. The investigators hypothesize that RIFPB at either concentration will reduce rescue tramadol consumption and pain scores compared with control, and that the lower concentration will halve the total bupivacaine dose (62.5 mg instead of 125 mg), thereby reducing the risk of LAST.