This is a single arm study, all patients will receive a fetoscopic repair of the spina bifida

Neural Tube Defects

Spina Bifida, Open

Myelomeningocele

Fetal Disease

Hydrocephalus

Chiari Malformation Type 2

Congenital Abnormality

Surgery; Maternal, Uterus or Pelvic Organs, Affecting Fetus

Fetoscopic intrauterine repair of open spina bifida

Fetoscopic repair of spina bifida

Hospital Universitari Vall d'Hebron

Fetal Endoscopic Surgery for Spina Bifida

Binary variable (yes/no) describing if the neural tube defect has been successfully closed, (placode dissected and dropped into the open spinal canal, cystic tissue resected and edges closed to the midline), by fetoscopic surgery, and without conversion to open surgery

Time between the skin opening and skin closure

Time between the introduction of the first cannula and the removal of the last cannula

Time between hospital admission and discharge

Binary variable describing if a transfusion of blood derivates is carried out between the time of procedure and discharge

Binary variable describing amniotic fluid leakage before the onset of labor

Binary variable describing the presence of a chorioamnionitis between the procedure and birth

Binary variable describing the presence of a oligohydramnios (deepest pool < 2 cm) without evidence of vaginal amniotic fluid leakage

Binary variable describing the presence of a placental abruption

Binary variable describing the mode of delivery, vaginal or cesarean section

Binary variable describing the presence of a uterine dehiscence, regardless of whether it is symptomatic or it is diagnosed at the time of cesarean section

Binary variable describing the presence of a maternal pulmonary edema, regardless of the severity, between the procedure and discharge.

Binary variable describing the watertight closure of the defect

Categorical variable describing if the postnatally assessed neurological level is better / same or worse than the level assessed prenatally before the procedure. It will be assessed by physical examination

Categorical variable comparing the postnatal and prenatal MRI assessment of the Chiari malformation

Binary variable describing the need of a ventriculoperitoneal shunting

Hospital Universitari Vall d'Hebron Research Institute

Active bilateral ultrasound-guided transmuscular quadratus lumborum (TQL) block. 60 ml ropivacaine 0,375% single shot.
In both arms, the participants receive 1g Acetaminophen and 400 mg Ibuprofen / 100 mg Celebra. Morphine will be administered IV as part of a PCA-pump regimen or additionally after contact with the nursing staff as it is the standard treatment.

Placebo bilateral ultrasound-guided transmuscular quadratus lumborum (TQL) block. 60 ml saline single shot.
In both arms, the participants receive 1g Acetaminophen and 400 mg Ibuprofen / 100 mg Celebra. Morphine will be administered IV as part of a PCA-pump regimen or additionally after contact with the nursing staff as it is the standard treatment.

Postoperative Pain

Only women scheduled for elective caesarean section are eligible.

30 ml ropivacaine 0,375% administered on each side as bilateral TQL blocks

Ropivacaine

30 ml saline 0,375% administered on each side as bilateral TQL blocks

Saline

Acetaminophen

Ibuprofen 400Mg Tablet / Celebra 100 Mg tablet

Transmuscular quadratus lumborum block, ultrasound-guided

ultrasound-guided nerve block

intravenously administered morphine via PCA-pump

Morphine

PCA-pump with IV-Morphine. 5 mg administered per bolus. Lock-out time and max. dosage standardized.

Patient-controlled analgesia

Ultrasound-guided Transmuscular Quadratus Lumborum Block for Elective Caesarean Section.

Ultrasound-guided Transmuscular Quadratus Lumborum Block for Elective Caesarean Section. A Double Blind, Randomized, Placebo Controlled Trial.

Data from PCA pump and patient medical record

NRS score will be recorded electronically on all morphine administrations, since all patients must enter their NRS score on the PCA pump display prior to administration of the PCA boluses.

0=Complete satisfaction 10=Unmanageable dissatisfaction

PONV. 0-3; 0=No nausea. 3=Unmanageable nausea

When does the new mother ambulate. I.e. Unassisted visit at the bathroom.

Zealand University Hospital

Treatment as usual without acetazolamide treatment

Thoracic Aneurysm

Acetazolamide twice a day, at 12 hour intervals:
250 mg Tablets; one tablet to be taken twice daily from three days before the day of surgery
One tablet to take two hours before surgery
500mg Intravenous Acetazolamide; to be administered upon arrival in critical care post-surgery; continuing at 12 hour intervals until last acetazolamide administration at 72 hours.

Acetazolamide

Liverpool heart & chest hospital

Liverpool Heart & Chest Hospital

Effectiveness of Acetazolamide in Reducing Paralysis of the Leg in Patients Undergoing Aortic Aneurysm Surgery Surgery

A Randomised Controlled Trial of the Effectiveness of Acetazolamide in Reducing Cerebrospinal Fluid Pressure for Patients Undergoing Thoracic-abdominal Aortic Repair

Reduction in frequency and volume of CSF drainage

The outcome is non-clinical paraplegia measured by amplitude of the motor evoked potentials during postoperative recovery. The signal amplitudes are compared to baseline established during surgery where the postoperative lower limbs amplitude reduction of over 50% and upper limb reduction of less than 50% equates to a risk of paraplegia.

Postoperatively, clinically evident paraplegia is assessed by the ability of patients to move limbs on awakening. This assessment is performed hourly until 72 hours after admission to the critical care unit and then once on the day of hospital discharge.

paraplegia/dental caries

Fetal Endoscopic Surgery for Spina Bifida

Ultrasound-guided Transmuscular Quadratus Lumborum Block for Elective Caesarean Section.

Effectiveness of Acetazolamide in Reducing Paralysis of the Leg in Patients Undergoing Aortic Aneurysm Surgery Surgery

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