Pain is as old as mankind.1 The word “pain” comes from the Latin word “poena,” which means “punishment.” The word “patient” is derived from the Latin word “patior,” meaning “to endure suffering or pain.”2

How to cite this article: Ramasamy G, Das G. Evolution of Pain Clinic. J Recent Adv Pain 2018;4(1):1-5.

Source of support: Nil

Conflict of interest: None

Aim: To compare the efficacy of intrathecal low-dose bupivacaine 5 mg (1 mL) plus fentanyl 25 μg (0.5 mL) with intrathecal low-dose bupivacaine 5 mg (1 mL) plus normal saline (NS) (0.5 mL) for perineal daycare surgery.

Materials and methods: Hundred patients in the age group 18 to 50 years of either sex with body weight of 40 to 100 kg and physical status American Society of Anesthesiologists (ASA) 1 and 2 undergoing daycare elective perineal surgery of duration less than 60 minutes under spinal anesthesia were randomly allocated into two groups with each 50 patients—group F, subarachnoid block with bupivacaine heavy 5 mg (1 mL) plus fentanyl 25 μg (0.5 mL) and group B, with bupivacaine heavy 5 mg (1 mL) with NS (0.5 mL). Subarachnoid block was performed in lateral position. Parameters including pulse rate, blood pressure, oxygen saturation with pulse oximeter, onset of anesthesia, block characteristics, and complications were noted and analyzed by independent author using Student’s t-test.

Results: The mean duration of analgesia was significantly high in group F compared with group B (p < 0.05) with no difference in anesthesia characteristic, hemodynamic variables, and complications.

Conclusion: The intrathecal fentanyl with low-dose bupivacaine intensifies surgical anesthesia with extended postoperative analgesia without extending neurological deficit and complications.

Clinical significance: This method is a very effective and cheap anesthesia modality in daycare perineal surgery.

Keywords: Anesthesia, Bupivacaine, Daycare, Fentanyl, Low volume, Perineal, Spinal, Subarachnoid.

How to cite this article: Anand MV, Nachimuthu V, Ramasamy G. A Prospective Comparative Study of Intrathecal Low-dose Bupivacaine 5 mg (1 mL) plus Fentanyl 25 μg (0.5 mL) with Intrathecal Low-dose Bupivacaine 5 mg (1 mL) plus Normal Saline (0.5 mL) for Perineal Daycare Surgery. J Recent Adv Pain 2018;4(1):6-9.

Source of support: Nil Conflict of interest: None

Aim: To assess and compare the postoperative analgesic effect of laparoscopy-guided transversus abdominis plane (TAP) block vs ultrasound-guided TAP block in patients undergoing Laparoscopy-assisted ventral hernia repair.

Materials and methods: A prospective randomized control trial was undertaken with 50 patients undergoing elective laparoscopic ventral hernia repair. The patients belonging to group I (n = 25) received 15 mL of 0.25% bupivacaine on both sides by ultrasound guidance at the end of the procedure, whereas those in group II (n = 25) received the same under laparoscopic guidance at the end of the procedure. Postoperative pain scores were measured using visual analog scale (VAS) both at rest and during motion at 0, 2, 4, 6, 12, and 24 hours postoperatively. Other parameters like the administration of first dose of rescue analgesic and time required for postoperative ambulation were also recorded.

Results: Demographic data, duration of surgery, and size of the hernial defect were comparable in both the groups. The total intraoperative opioid consumption was also similar in both the groups (p = 0.740). The pain scores at rest as well as during motion were comparable at all points between the two groups. The time required for the administration of first dose of rescue analgesic as well for postoperative ambulation was also similar in both the groups.

Conclusion and clinical significance: Our study establishes that laparoscopy-guided TAP block is an effective modality to provide analgesia for patients undergoing laparoscopy-assisted ventral hernia repair. Ultrasound-guided TAP block has been long established as an effective modality in providing postoperative analgesia. However, the nonavailability of ultrasound machines in operating rooms especially in developing countries like ours limits its use in a perioperative setting. Laparoscopyguided TAP block might be as effective, easier, and probably less time consuming than ultrasound-guided TAP block.

Keywords: Laparoscopy, Laparoscopy-guided transversus abdominis plane block, Postoperative analgesia, Prospective study, Ultrasound-guided transversus abdominis plane block, Ventral hernia.

How to cite this article: Shankar V, Raj A, Chatterjee C, Prasad A, Tiwary A. A Study comparing the Analgesic Efficacy of Ultrasound-guided TAP Block vs Laparoscopy-guided TAP Block in Patients undergoing Laparoscopy-assisted Ventral Hernia Repair. J Recent Adv Pain 2018;4(1):10-14.

Source of support: Nil

Conflict of interest: None

Introduction: There is a list of additives for supraclavicular block to facilitate onset, intensity, and duration of the block, which may also be prudent for postoperative analgesia.

Aim: To compare dexamethasone and tramadol in combination with bupivacaine in terms of duration of sensory and motor block, onset of block, postoperative duration of analgesia and safety.

Materials and methods: Sixty patients of American Society of Anesthesiologists (ASA) physical status I and II undergoing below elbow surgery under brachial plexus block were randomly allocated in two groups of 30 each to receive either dexamethasone 8 mg + bupivacaine (0.5%) (0.5 mL/kg) (group I) or tramadol 1 mg/kg + bupivacaine (0.5%) (0.5 mL/kg) (group II). Primary objectives were to study the onset of sensory and motor blockade, duration of sensory and motor blockade, and duration of analgesia. Secondary objective was to study the side effects. Two-sample t-test was used to compare various parameters like onset of sensory blockade, onset of motor blockade, sensory offset, motor offset, and duration of analgesia.

Results: The onset of sensory blockade in groups I and II (7.86 ± 1.63 vs 8.68 ± 1.74 minutes, respectively) and onset of motor blockade (9.63 ± 1.28 minutes in group I and 9.86 ± 1.42 minutes in group II) were statistically comparable while duration of sensory blockade (1038 ± 112.4 minutes in group I and 302.8 ± 27.50 minutes in group II), duration of motor blockade (889.5 ± 89.4 minutes in group I and 274.5 ± 27.08 minutes in group II), and postoperative duration of analgesia (20.43 ± 1.75 hours in group I and 7.08 ± 1.47 hours in group II) were significantly prolonged in group I compared with group II. No significant side effects were seen in any of the groups.

Conclusion: Addition of dexamethasone to 0.5% bupivacaine in supraclavicular brachial plexus block significantly prolongs the duration of sensory and motor blockade and postoperative duration of analgesia when compared with tramadol as additive. Both the drugs were comparable in terms of safety.

Keywords: Additive, Dexamethasone, Supraclavicular block, Tramadol.

How to cite this article: Apte VY, Jamkar MA. Comparison of Bupivacaine with Tramadol vs Bupivacaine with Dexamethasone in Supraclavicular Block: A Prospective Randomized Doubleblind Study. J Recent Adv Pain 2018;4(1):15-18.

Source of support: Nil

Conflicts of interest: None

Objective: Intravenous regional anesthesia (IVRA) is used for short procedures for hand and upper limb surgeries. In terms of analgesia duration and quality of anesthesia, IVRA with adjuvants like opioids, muscle relaxants, nonsteroidal anti-inflammatory drugs (NSAIDs) increases the efficacy. We conducted this comparative study for evaluating the effect of adding magnesium sulfate and clonidine with lignocaine in IVRA for upper limb surgeries.

Materials and methods: Seventy-five patients with American Society of Anesthesiologists (ASA) class I and II of either sex, age 18 to 60 years, undergoing upper limbs surgeries were enrolled. They were divided into three groups (25 each) according to drug received. Group L: 9 mL of 2% lignocaine (preservative-free) diluted with normal saline to make a total volume of 36 mL of 0.5% lignocaine. Group M: 3 mL of 50% magnesium sulfate with 9 mL of 2% lignocaine diluted with normal saline to make total volume of 36 mL, 0.5% lignocaine. Group C: 1 μg/kg clonidine with 9 mL of 2% lignocaine diluted with normal saline to make total volume of 36 mL of 0.5% lignocaine. Sensory and motor block (onset and recovery time), intraoperative tourniquet pain, first tramadol requirement time and mean tramadol dosage, quality of operative conditions, hemodynamic parameters, postoperative pain scores [in visual analog scale (VAS)] were recorded.

Results: Both groups were comparable in terms of age, sex, ASA grade, baseline hemodynamic parameters, duration of surgery, and tourniquet inflation time. Shortened sensory and motor block onset times were established in M group (p < 0.05). Recovery from sensory and motor blockade was significantly prolonged in M group (p < 0.05). Anesthesia excellence as determined by anesthesiologist and surgeon was significantly better in C group as compared with rest of the two groups (p < 0.05). There was statistically significant difference (p > 0.05) in intraoperative VAS scores in groups M and C as compared with group L, throughout the procedure. Time to first analgesic requirement in group C was 43.04 ± 27.46 minutes, group M 42.72 ± 18.06 minutes, and group L was 27.08 ± 4.45 minutes (p < 0.05). Postoperative VAS scores for 24 hours were higher in group L as compared with groups M and C (p < 0.05).

Conclusion: Magnesium sulfate as an adjuvant to lignocaine hydrochloride for IVRA for upper limb surgeries shortens the onset of sensory and motor block to a greater extent as compared with clonidine and lignocaine alone, though postoperative analgesia was found to be of longer duration with clonidine as an adjuvant.

Keywords: Biers block or intravenous regional anesthesia, Clonidine, Lignocaine hydrochloride, Magnesium sulfate.

How to cite this article: Solanki D , Singh M. Intravenous Regional Anesthesia: Comparing Efficacy of Magnesium Sulfate and Clonidine as an Adjuvant to Lignocaine for Intraoperative and Postoperative Analgesia. J Recent Adv Pain 2018;4(1):19-24.

Source of support: Nil

Conflicts of interest: None

Introduction: Major depressive disorder (MDD) is one of the most common mental disorders and frequently associated with chronic pain. This chronic pain can be widespread or localized and regional. Questions have been raised whether severity of major depression is more associated with widespread pain, or it can be equally associated with localized and regional pain. The purpose of this study is to identify the association of depression with areas of pain and whether depression is more severe in widespread pain.

Materials and methods: A cross-sectional study was conducted on patients attending Daradia Pain Clinic, Kolkata. Patients suffering from both chronic pain and depression of any age and sex who attended this clinic between April 2015 and March 2017 were selected. The patients were divided into two groups: Group I comprised patients with widespread pain with widespread pain index (WPI) ≥4 and group II comprised patients with regional pain with WPI ≤3. All the clinical and demographic variables were analyzed and severity of depression was compared between the two groups.

Results: Variables like age, Patient Health Questionnaire 9 (PHQ-9), and numerical rating scale (NRS) scores showed comparability (p-value > 0.05) in both the groups (in group I, n = 2 46; in group II, n = 125), while the gender distribution was found highly significant (p-value = 0.0003) for females in chronic widespread pain (CWP) (73.79% in group I vs 52.76% in group II). The subgroups of moderate (PHQ-9 ≤ 14) and severe (PHQ-9 ≥ 15) depression showed no statistical significance (p-value > 0.05).

Conclusion: Our study concluded that severity of depression is equally common with chronic pain whether it is regional and localized or widespread. Females suffer more from widespread pain with depression.

Keywords: Chronic widespread pain, Depression, Patient health questionnaire-9, Severe depression.

How to cite this article: Nagaraj P, Das G, Sharma RS, Gupta S. Is Major Depression More Commonly associated with Widespread Pain? A Cross-sectional Study to identify Any Relation J Recent Adv Pain 2018;4(1):25-31.

Source of support: Nil

Conflict of interest: None

Trying to treat something, i.e, invisible brings forth challenges, obstacles, and belief systems that may prevent proper treatment. Chronic pain clearly falls into this category but the undertreatment of pain exists in all aspects of health care. One main reason for this misery is the existence of inadequate knowledge among clinicians regarding pain management. The basic knowledge about the pain pathway, modulation of pain, concept of sensitization, psychological aspect of pain, use of different pharmacological agents in various types of pain along with pathophysiology of chronic and persistent pain is very important in understanding different kinds of pain in a better way. But unfortunately, in our undergraduate and postgraduate curriculums, not much emphasis has been made on this important matter. Hopefully, busting these deficiencies among clinicians will ensure that no one lives with unnecessary pain or receives an incomplete pain treatment plan again.

Keywords: Chronic pain, Pain pathway, Sensitization.

How to cite this article: Sharma RS, Das G. What is the Minimum Knowledge of Pain Medicine needed for Other Specialty? J Recent Adv Pain 2018;4(1):32-35.

Source of support: Nil

Conflict of interest: None

Trigeminal neuralgia is the commonest cause of facial pain after 50 years. If medical treatment is insufficient or has too many side effects, an invasive treatment should be carried out. There are three interventions that can be done by pain physicians to provide pain relief, which are radiofrequency (RF) ablation of the Gasserian ganglion, percutaneous glycerol rhizolysis, and percutaneous balloon decompression. Out of these, RF ablation technique is the most commonly used. These interventions are little bit technically demanding because many important structures are situated in the vicinity of Gasserian ganglion, but with better knowledge of fluoroanatomy and needling skill, one can perform this procedure safely and with great success.

Keywords: Headache, Radiofrequency ablation, Trigeminal neuralgia.

How to cite this article: Sharma G, Dey S. Trigeminal Neuralgia: Radiofrequency Ablation. J Recent Adv Pain 2018;4(1):36-38.

Source of support: Nil

Conflict of interest: None

Internal disk disruption (IDD) is a common cause of disabling low back pain (LBP) in a substantial number of young, healthy adults. The IDD is a common entity; nearly 30 to 50% of subjects with chronic LBP have IDD. Most of the patients experience a diffuse, dull ache or a deep-seated, burning, lancinating pain in the back. Referral of pain into the hips and lower limbs is not uncommon. In acute cases, a history of lifting trauma precedes the back pain. In the chronic stage, pain and muscle spasm are less dramatic and more nondescript. Typically, there is no objective evidence of radiculopathy, even in those who have a radicular pattern of pain referral. We report four cases with history of gradual-onset LBP of moderate intensity radiating up to lower limb. There was associated weakness and numbness along the lower limb. The area of distribution of pain was similar to radicular pattern. Tingling and burning sensation were also evident along with the pain. Pain was mainly restricted over the buttock along with lower extremity area. Examination findings revealed similar pain in almost all the cases, revealing mild tenderness over buttock on deep palpation, and the flexion, adduction and internal rotation (FAIR) test was weakly positive. Most of the magnetic resonance imaging (MRI) findings were normal except for the presence of a hyperintense zone (HIZ) in area adjoining disk. So, the first differential diagnosis of piriformis syndrome was made. Diagnostic piriformis injections were performed with local anesthetic in a fan-shaped manner along the direction of muscle fibers without significant improvement. Considering the IDD as another differential diagnosis, also evident by the presence of HIZ in MRI, ramus communicans block was performed. There was significant pain reduction along with improvement of other symptoms like weakness, tingling, and burning sensation following the ramus communicans block.

Keywords: Internal disk disruption, Radiculopathy, Ramus communicans block.

How to cite this article: Sharma RS, Das G, Chavda P, Suyashi DR. Atypical Cases of Internal Disk Disruption mimicking Radiculopathy: A Case Series Study. J Recent Adv Pain 2018;4(1):39-43.

Source of support: Nil

Conflict of interest: None

Although the incidence of mortality from colorectal cancer is declining, it is still the fourth most common condition in men and the third most common in women worldwide. Several studies have reported neoplastic involvement of lumbosacral plexus, which results in the patient suffering. The L5-S1 and sciatic nerves are most frequently involved. Clinically, these patients present with pain followed by numbness and weakness. We propose a thorough knowledge of lumbosacral plexus anatomy and diagnostic block, a important tool of pain physician which can be effectively used to diagnose, treat and reduce cancer pain.

Keywords: Colorectal cancer, Diagnostic block, Lumbosacral plexus.

How to cite this article: Mahawar B, Mahawar V, Sahi M. Role of Diagnostic Block in S1 Radiculopathy in a Patient of Carcinoma Rectum with Leg Pain. J Recent Adv Pain 2018;4(1):44-46.

Source of support: Nil

Conflict of interest: None

Psoas myofascial pain syndrome, a term applied to the abnormal condition of the psoas muscle, is characterized by symptoms and signs due to entrapment of the lumbar plexus. Psoas syndrome is an easily missed diagnosis. However, it is important to consider this condition as part of the differential diagnosis for patients presenting with low back pain radiating to lower limbs. Here, we report an unusual case of low back pain, radiating to right thigh. On examination, patient had paramedian tenderness over right lower back along with loss of sensation over inguinal and anterior aspect of thigh. The patient was successfully managed by local anesthetic injection along psoas myofascial plane.

Keywords: Low back pain, Lumbar plexus, Myofascial pain syndrome.

How to cite this article: Joshi VS, Das G, Sharma RS. Unusual Case of Psoas Myofascial Pain Syndrome mimicking Radiculopathy. J Recent Adv Pain 2018;4(1):47-49.

Source of support: Nil

Conflict of interest: None