Emergence agitation (EA) is a common postoperative issue in children that causes self-injury, increases stress on healthcare team members, and even leads to postoperative maladaptive behavioral changes in children. Clear answers regarding a ‘gold standard’ for prevention of EA are not available. Pain is regarded as an important causative factor of EA, and ultrasound-guided lumbar plexus block is a safe and efficient anesthetic method that can provide satisfactory pain relief in pediatric hip surgery. The purpose of our study is to determine whether ultrasound-guided lumbar plexus block can reduce the incidence of EA in children undergoing hip surgery. We designed a prospective, randomized, controlled, blinded trial to determine the effect of ultrasound-guided lumbar plexus block on EA. A total of 100 American Society of Anesthesiologists class I–II children (1–6 years old) scheduled for elective hip surgery will be recruited for this study. Participants will be randomized at a 1:1 ratio to receive either ultrasound-guided lumbar plexus block or fentanyl after the induction of general anesthesia. The primary outcome is the incidence of EA 30 min after emergence from anesthesia using the Pediatric Anesthesia Emergence Delirium (PAED) score. The secondary outcomes are the severity and duration of EA 30 min after emergence from anesthesia using the PAED score, postoperative pain evaluated by the Children’s Hospital of Eastern Ontario Pain Scale, and the incidence of postoperative adverse events. Randomization will be conducted using a computer-generated randomization schedule. Outcome assessors and data collectors will be blinded to the group allocations. Assessments will be performed before surgery, intraoperatively, and postoperatively at every time point. Our hypothesis in this trial is that ultrasound-guided lumbar plexus block can decrease the incidence of EA in children undergoing elective hip surgery. This trial will provide clinical answers to verify our hypothesis. If our hypothesis is confirmed, the results could provide a safe method to prevent EA. Chinese Clinical Trial Registry, ChiCTR-INR-17011525 . Registered on 30 May 2017.

Background: The innervation of the shoulder-upper-extremity area is complicated and unclear. Regional anesthesia with a brachial plexus and cervical plexus block is probably inadequate for the proximal humeral surgery. Missing blockade of the T1–T2 nerves may be the reason. We conduct this prospective randomized controlled trial (RCT) to explore whether an additional T2 thoracic paravertebral block (TPVB) can improve the success rate of regional anesthesia for elderly patients in proximal humeral fracture surgery. Methods/design: The patients aged 65 years or older, referred for anterior-approach proximal humeral fracture surgery, will be enrolled. Each patient will be randomly assigned 1:1 to receive a combined interscalene brachial plexus with superficial cervical plexus block (IC) (combined interscalene brachial plexus with superficial cervical plexus block) or an IC block combined with thoracic paravertebral block (ICTP) block (combined thoracic paravertebral block with brachial plexus and superficial cervical plexus block). The primary outcome is the success rate of regional anesthesia without rescue analgesic methods. The secondary outcomes are as follows: sensory block at the surgical area, proportion of patients who need rescue anesthesia (intravenously administered remifentanil or conversion to general anesthesia), cumulative doses of intraoperative vasoactive medications and adverse events. The total sample size is estimated to be 80 patients. Discussion: This RCT aims to confirm whether an additional T2 TPVB can provide better anesthetic effects of regional anesthesia with brachial and cervical plexus block in elderly patients undergoing proximal humeral surgery. Trial registration: ClinicalTrials.gov, ID: NCT03919422. Registered on 19 April 2019.

Postoperative sore throat (POST) is a common complaint after general anaesthesia. The prevalence of POST caused by a neural integrity monitor electromyography endotracheal tube (NIM-EMG-ETT) is high. This study aimed to determine whether ultrasound-guided internal branch of superior laryngeal nerve block (iSLNB) could alleviate POST associated with a NIM-EMG-ETT. This randomized controlled trial plans to enroll 182 patients scheduled to undergo general anaesthesia with a NIM-EMG-ETT. Patients will be randomly allocated into the iSLNB group or the control group according to randomized numbers generated by Excel. After induction, patients in the iSLNB group will undergo ultrasound-guided iSLNB with ropivacaine, and patients in the control group will undergo the same procedure with normal saline. The prevalence, severity, visual analogue scale score of POST, and postoperative acoustic analysis will be recorded. To the best of our knowledge, this is the first study to evaluate the effect of ultrasound-guided iSLNB with ropivacaine on the mitigation of POST induced by NIM-EMG-ETT. Our study will provide clinical answers to alleviate POST induced by NIM-EMG-ETT. The results of this study may provide a safe method to prevent POST caused by NIM-EMG-ETT. Chinese Clinical Trial Registry, ChiCTR2300076393. Registered on October 24, 2023, http://www.chictr.org.cn/index.aspx .

This study aimed to evaluate the efficacy and safety of ultrasound-guided lumbar plexus block (LPB) combined with transmuscular quadratus lumborum block (TQLB) at the L3 level using the Shamrock approach for total hip arthroplasty. Eighty-four patients were enrolled and randomly assigned into three groups at a 1:1:1 ratio: P group (LPB at L3 level), TP group (T12 paravertebral block combined with LPB at L3 and L4 levels) or PQ group (LPB combined with TQLB at L3 level). The primary outcome was the effective rate of sensory block, assessed via the cutaneous sensory block area. The secondary outcomes included postoperative pain intensity, intraoperative sufentanil consumption, incidence of hypotension, procedure time of block and complications. The PQ group achieved a significantly higher effective rate of 67.6% compared to the P group, which was at 7.1% (p < 0.001), though lower than the TP group (89.3%, p = 0.051). The PQ group demonstrated significantly lower postoperative visual analogue scales (VAS) during movement compared to the P group (PACU: p = 0.009; 6 h: p = 0.046; 24 h: p = 0.006). However, no significant differences were observed between the PQ and TP groups under any condition (rest or movement). Sufentanil consumption remained comparable across the three groups. Notably, the PQ group experienced a lower frequency of intraoperative hypotension compared to the TP group (p = 0.028). Regarding procedure time, the PQ group exhibited a significantly lower mean value compared to the TP group, but it was higher than that in the P group (p < 0.001). Furthermore, no clinical signs of local anaesthetic systemic toxicity, nerve injury, haematoma or epidural block were observed in any of the groups. The combined technique may provide effective block with fewer technical challenges and hypotension risks compared to multi-level LPB, making it a feasible alternative for perioperative pain management in total hip arthroplasty. Trial registration ClinicalTrials.gov, NCT04266236. Registered on 10 February 2020. ClinicalTrials.gov PRS: Record Summary NCT04266236.