Wounds and Injuries

All Conditions

Symptoms and General Pathology

Neoplasms

Pain

Abdominal Neoplasms

an epidural catheter will be inserted under sterile conditions through the T9- 12 interspace using the 'loss-of-resistance' technique. The catheter will be advanced 4 cm cephalad. .

preperitoneal catheters will be placed in the subfascial (ie, pre-peritoneal) space under direct vision.

epidural catheter

preperitoneal catheter

fatma el sherif, M.D

Ahmad M Abd El-Rahman, M.D

the investigators aim is to investigate the effect of continuous preperitoneal bupivacaine wound infiltration versus epidural analgesia on the inflammatory cytokines response following radical cytectomy

Continuous Pre-peritoneal Wound Infiltration Versus Epidural Analgesia in Cancer Surgery

Effect of Continuous Pre-peritoneal Wound Infiltration Versus Epidural Analgesia on Inflammatory Response and Pain Following Radical Cytsectomy

Blood samples taken all over the 24-hr. period were collected in plasma tubes containing ethyl-enediamine-tetra-acectic (EDTA), centrifuged and stored at 20○c for assessment of Plasma concentrations plasma IL 1, IL 6, IL10 and TNF to assess inflammatory cytokines

pain intensity was assessed using a 10-cm VAS (0 = no pain and 10 = worst imaginable pain)

observation of side effects and record incidence as nausea, vomiting and itching

scale ranging 1-4 :unsatisfactory, regular, satisfactory and excellent)

Assiut University

lecturer of anesthesia ,icu and pain management

Dermoid Cyst

Cysts

Teratoma

Neoplasms, Germ Cell and Embryonal

Neoplasms by Histologic Type

Central Nervous System Depressants

All Drugs and Chemicals

Anesthetics

Pilonidal dermoid cyst surgery in Spinal anaesthesia

Pilonidal dermoid cyst surgery in Epidural anaesthesia

epidural anaesthesia application for spinal catheter will be used

spinal anesthesia application for spinal catheter will be used

spinal catheter

Turgut Donmez, Surgeon

Vuslat Muslu Erdem, anesthetist

Turgut Donmez, MD

Pilonidal dermoid cyst surgery under general anesthesia and regional anesthesia techniques is used.regional anesthesia techniques; spinal, epidural, spinal epidural (combined) and is the local anesthesia.In the investigators study, pilonidal dermoid cyst surgery in spinal and epidural anesthesia techniques activity, reliability will be compared to the side effects and complications.

One hundred patients will be randomly assigned to either the pilonidal dermoid cyst under Spinal anaesthesia (50 patients)(Group 1) or pilonidal dermoid cyst under epidural anaesthesia (50 patients)(Group 2). Group 1 will be used in spinal catheter in spinal anesthesia procedures or Group 2 will be used epidural catheter in epidural anaesthesia procedures.All patients has symptomatic pilonidal dermoid cyst.

Pilonidal dermoid is a tubular skin defect which can be seen in both female and male patients between the ages of 12 to 80. Treatment alternatives includes surgical excision. During the surgical treatment local, general, spinal or epidural anesthesia could be applied. However, local anesthesia usually is not preferred due to the fact that pilonidal dermoid sinuses depth, width could not be determined precisely. General anesthesia also is not preferred due to the fact that difficulties arising from patient's positioning and positioning based potential lung related problems. In general, spinal anesthesia and epidural anesthesia is preferred for pilonidal dermoid sinus surgeries. In this study, the investigators will demonstrate advantages, disadvantages, complications, (sensory and motor block levels), and durations of spinal and epidural anesthesia and superiority of each on these subjects.

Patients who are over 18 and have a America Society of Anesthesiologist (ASA) physical score of I and II will be included in the study. Patients who are pregnant, have a known allergic reactions to local anesthetic and have contraindications against spinal and epidural anesthetic will be excluded from the study.

In this study the investigators separate the patients into 2 groups. Group1: pilonidal dermoid cyst under Spinal anaesthesia (50 patients).Group 1 will be used in spinal catheter in spinal anesthesia procedures ; Group2:pilonidal dermoid cyst under epidural anaesthesia (50 patient).Group 2 will be used epidural catheter in epidural anaesthesia procedures. All patients has symptomatic pilonidal dermoid cyst

Epidural and Spinal Anesthesia Techniques in Pilonidal Dermoid Sinus Surgeries

Epidural and Spinal Anesthesia Techniques in Pilonidal Dermoid Sinus Surgeries: Prospective Randomized Trials

Lütfiye Nuri Burat Government Hospital

General Surgeon, MD

Digestive System Diseases

Gland and Hormone Related Diseases

Nervous System Diseases

Rare Diseases

Pancreatic Neoplasms

Postoperative Complications

Pain, Postoperative

Neurologic Manifestations

Pancreatic Cancer

Patients randomized to recieve epidural catheter placement with LOS technique, without any Rx control

Patients randomized for X-ray placement of epidural catheter

placement of epidural catheters with LOS technique

placement of epidural catheters with x-ray guide

X-ray placement

Alvise Martini, MD

The use of epidural catheters for postoperative analgesia in pancreatic surgery is recommended by the guidelines of the ERAS society. Some studies claim it may expose to hemodynamic alterations that may compromise outcome and increase postoperative complications, attributable to a malfunction of the catheter itself, often linked to a bad positioning, since this is usually positioned with LOS technique. Our hypothesis is that a positioning made using the radiographic guide the day before the intervention can significantly reduce the number of catheter's dysfunctions.

About 30% of epidural catheters are reported to have hypo or hyper functioning behaviour. This has and impact on postoperative pain control and can affect also surgical and global outcome since it is known that a malfunctional catheter carries an increased complication's rate.

Our hypothesis is that rx-guided positioning can reduce the incidence of catheter malfunction afrom 30 to 15 %.

PERiX: Comparison of Efficacy Between Placement of Epidural Catheters X-ray Guided and LOS Technique

PERiX: Comparison of Efficacy Between Placement of Epidural Catheters X-ray Guided and LOS Technique: Outcome Influence on Patient Underwent Pancreatic Surgery

malfunctional catheters are defined as following:

* symptomatic hypotension due to epidural infusion
* NRS \> 6 in the first postoperative day and NRS \> 4 in subsequent postoperative day
* overt malpositioning:
* rx evidence of catheter's tip under T10 during routine rx or TC
* NRS \> 6 (due to pain at T7-10 dermatomers) with 5 cc/h catheter infusion and response to lidocaine 1% 6ml bolus (low tip)
* NRS \> 6 (due to pain at T7-10 dermatomers) with 5 cc/h catheter infusion and NO response to lidocaine 1% 6ml bolus ( not in epidural space or very low tip)
* evidence of catheter accidental removal

Numerical Rating Scale (NRS) is used to assess pain. Patients self-report actual pain on 0 to 10 scale where 0 is no pain and 10 is the worst immaginable pain.

Parameter used

-higher postoperative daily numeric rating scale (NRS) until catheter removal

Numerical Rating Scale (NRS) is used to assess pain. Patients self-report actual pain on 0 to 10 scale where 0 is no pain and 10 is the worst immaginable pain.

Complications are considered as:

* bleedings
* infections
* pancreatic fistulas (degree)
* biliary fistulas
* abdominal collections
* ICU admission
* needs of new surgery (for any reasons)
* pneumonia
* delayed gastric emptying

Azienda Ospedaliera Universitaria Integrata Verona

MD, Principal Investigator

Behaviors and Mental Disorders

Stomach Neoplasms

Delirium

Emergence Delirium

Confusion

Neurobehavioral Manifestations

Neurocognitive Disorders

Mental Disorders

Psychotic Disorders

Stomach Cancer

Adjuvants, Anesthesia

Analgesics

Pharmaceutical Solutions

Anticoagulants

Other Dietary Supplements

Sufentanil

Ropivacaine

Analgesics, Opioid

Citric Acid

Sodium Citrate

Dsuvia

Anesthetics, Local

Narcotics

Anesthetics, Intravenous

Anesthetics, General

Citrate

Combined use of sufentanil and ropivacaine for intraoperative and postoperative analgesia

Only use of ropivacaine for intraoperative and postoperative analgesia

Intraoperative loading dose of sufentanil 0.6μg/kg, each additional hour 10μg, within one hour of the end of surgery to stop additional.Postoperative analgesia pump formula: sufentanil 150ug + 0.75% ropivacaine 60ml with 0.9% saline diluted to 220ml, 3ml

Sufentanil Citrate

Intraoperative epidural analgesia was performed with 0.5% ropivacaine 5-20 ml,Postoperative analgesia pump formula:0.75% ropivacaine 60ml with 0.9% saline diluted to 220ml, 3ml/h, Blos 3ml, locking time 15min, the maximum dose of 36ml in 4 hours Saline is used to dilute other drugs

Ropivacaine 0.75% Injectable Solution

Intraoperative and postoperative analgesia

Epidural catheter

chaoqun Fei

The purpose of this study was to investigate whether perioperative use of low doses of opioids could reduce postoperative delirium .

Postoperative delirium (POD) is a common postoperative complication of the elderly caused by a variety of factors. POD is an acute neuropsychiatric disorder characterized by disturbance of attention consciousness and cognitive function fluctuation, and more than 40% of elderly patients have symptoms of hypoactivity POD.The incidence of POD is as high as 17% to 61% in patients with neurocognitive impairment and patients undergoing complex or emergency surgery, which usually occurs between 1 and 3 days after surgery. POD will lead to prolonged hospital stay, functional impairment and even death. How to prevent and treat POD is an urgent clinical problem to be solved at present.

Opiates are commonly used perioperative sedatives and analgesics, which may be associated with the occurrence of postoperative POD in elderly patients and increase the risk of POD. It is not clear whether perioperative use of low doses of opioids could reduces the incidence of POD in elderly patients. In this study, reducing-opioids anesthesia was defined as the use of 1/3 of the conventional opioid dose to observe whether reducing-opioids anesthesia affected the incidence of POD in elderly patients undergoing gastric cancer surgery

Whether Opioids Are Factor That Induced POD?

Whether Opioids Are Factor That Induced Postoperative Delirium?

this study individual statistics is not available

confusion assessment method for the ICU(CAM-ICU)

Richmond agitation and sedation scale(RASS), the RASS score was divided into 10 sedation scales, ranging from +4 to -5, representing the patient's degree from "aggressive" to "unconscious," with each score corresponding to a state of consciousness. When the RASS score was ≥-3, the CAM-ICU assessment was performed.

VAS is a scale of 11 numbers ranging from 0 to 10, with 0 representing no pain and 10 representing the most pain. Patients choose one of the 11 numbers to represent the pain level according to their own pain.

0: no pain;

Less than 3 points: mild pain, tolerable;

4-6 points: the patient's pain and affect sleep, still tolerable;

7-10: Patients have increasing pain, pain is unbearable, affect appetite, affect sleep.

Hypertension or hypotension was defined as an increase or decrease in mean arterial pressure of more than 30% at baseline

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Continuous Pre-peritoneal Wound Infiltration Versus Epidural Analgesia in Cancer Surgery	NCT03002909	Abdominal Neopl...	epidural cathet... preperitoneal c...	18 Years - 60 Years	Assiut University
Epidural and Spinal Anesthesia Techniques in Pilonidal Dermoid Sinus Surgeries	NCT02580500	Sinus; Dermal, ...	epidural cathet... spinal catheter	18 Years - 70 Years	Lütfiye Nuri Burat Government Hospital
PERiX: Comparison of Efficacy Between Placement of Epidural Catheters X-ray Guided and LOS Technique	NCT03685370	Postoperative P... Postoperative C... Pancreatic Canc... Haemodynamic In...	LOS X-ray placement	18 Years - 80 Years	Azienda Ospedaliera Universitaria Integrata Verona
Whether Opioids Are Factor That Induced POD?	NCT05596071	Postoperative D...	Sufentanil Citr... Ropivacaine 0.7... Epidural cathet...	65 Years -	Zhejiang Cancer Hospital
PERiX: Comparison of Efficacy Between Placement of Epidural Catheters X-ray Guided and LOS Technique	NCT03685370	Postoperative P... Postoperative C... Pancreatic Canc... Haemodynamic In...	LOS X-ray placement	18 Years - 80 Years	Azienda Ospedaliera Universitaria Integrata Verona

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