Clinical Research Directory

Implementation of a Pain Management Plan in Major Open Abdominal Surgeries.

Introduction: Major abdominal surgery encompasses a broad range of surgical procedures in heterogeneous patient populations.Management of postoperative pain has received keen attention in recent years with considerable concurrent advancement in the field.Despite this improvement,postoperative pain continues to be a challenge since suboptimal postoperative pain control is a risk factor for persistent surgical pain,increased morbidity,poorer functional recovery and reduced quality of life.Therefore,analgesic strategies should regard patients' factors as well as surgical procedures peculiarities.Since efforts are made throughout the years and are of utmost importance as numerous analgesic options exist for the effective pain control after abdominal surgeries including multiple classes of drugs and routes of administration(i.e.parenteral,regional,neuraxia.)In the context of the current surgical environment where improvement has been made,emphasis is placed on precision,minimizing trauma and improving the outcome.The choice of postoperative pain analgesic modality,is at the discretion of the primary anaesthesiologist and the choice depends upon the plan favored by him/her as well as the availability of drugs and equipment.Continuous re-evaluation of analgesic strategies is a necessary step toward establishing a better pain management plan in major abdominal surgeries and to design guidelines to improve our clinical approach. Study Objective: The target of the study is to compare the outcome of the selected analgesic combination of local anaesthetic and opioid(ropivacaine+fentanyl or ropivacaine +morphine)for postoperative continuous infusion,aiming to relief successfully the pain,on patients undergoing major abdominal surgeries based on hemodynamic and clinical findings. The study aims to highlight the positive impact of the chosen analgesic combination during the intraoperative period,the postoperative recovery period and also during the follow up periods in terms of physical function,pain intensity during activity,adverse effects and self efficacy. Methods: The study is prospective,comparative aiming to identify the pain management agents that will provide the best postoperative relief in order to be established and used as a primary choice to patients undergoing major open abdominal surgeries .All patients included will receive the same analgesic technique(epidural)chosen preoperatively by the anaesthesiologist in charge.All study participants are informed in detail and written informed consent is obtained.The study is in accordance with the regulations of the Declaration of Helsinki on human studies and the Greek legislation. The investigators will study 58 patients,equally divided into two groups, aged 18-80 years,administered to Evangelismos General hospital,Athens-Greece, for elective open abdominal surgeries. In group A(p:29),the investigators will administer for postoperative pain relief - Ropivacaine 200 ml/400 mg + Fentanyl for continuous epidural infusion for the first 5 days.The infusion will start 2 hours before the end of the operation and before the admission to the intensive care unit. In group B(p:29),the investigators will administer for postoperative pain relief Ropivacaine 200ml/400mg + Morphine for continuous epidural infusion for the first 5 days.The infusion will start 2 hours before the end of the operation and before the admission to the intensive care unit.

Analysis of the Molecular Composition of Tubal Cilia in Patients With or Without Ectopic Pregnancy

Primary Ciliary Dyskinesia associated with abnormalities of lateralization of organs (with existence of a situs inversus in 50% of cases) and secondary fertility disorders related in humans to abnormalities of mobility of sperm but very little data on the structure and function of tubal cilia in women

Preventing Ovarian Cancer Through Opportunistic Salpingectomy at the Time of Laparoscopic Cholecystectomy

This study aims to evaluate the feasibility, safety, and cost-effectiveness of opportunistic salpingectomy (OS-the removal of the fallopian tubes) at the time of laparoscopic cholecystectomy (the removal of the gallbladder) to prevent ovarian cancer. Ovarian cancer is the fifth leading cause of cancer-related mortality in females in Canada. OS can prevent the most common and lethal type of ovarian cancer, high-grade serous carcinoma (HGSC). OS during gynecologic surgery (hysterectomy or instead of tubal ligation) is safe and effective. However, rates of hysterectomies and tubal sterilization are decreasing. This research team aims to extend the prevention of ovarian cancer by expanding to offer OS during other surgeries in the abdomen, when patients are already undergoing a surgical procedure. This study will examine: 1) the feasibility of OS at the time of laparoscopic cholecystectomy; 2) the safety of OS at the time of laparoscopic cholecystectomy; 3) any health services consequences of offering OBS during laparoscopic cholecystectomy. The hypothesis is that OS at the time of laparoscopic cholecystectomy is a feasible, safe, and cost-effective primary prevention strategy for ovarian cancer. It is also hypothesized that there will be 10-20 minutes of additional operating room time for completing OS, and that integrating the identified partners and knowledge users, as well as adding relevant knowledge users as the project progresses, will affect the rapid mobilization of our findings.

SALpingectomy for STERilization (SALSTER)

The SALSTER study is a register-based randomized clinical trial (R-RCT) that examines if laparoscopic salpingectomy instead of tubal ligation, as a contraceptive method, has no increased risk for complications and has no negative impact on ovarian function.

Stop Ovarian Cancer Young; Effect of the Opportunistic Salpingectomy on Age of Menopause

The aim of this study is to evaluate the long-term safety of on the onset of menopause.