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ORIGINAL ARTICLE
Vikram I Shah, Sachin Upadhyay, Kalpesh Shah, Ashish N Sheth, Amish Kshatriya, Deepak Saini

Multimodal Cocktail Injection relieves Postoperative Pain and improves Early Rehabilitation following Total Knee Replacement: A Prospective, Blinded and Randomized Study

[Year:2017] [Month:January-April] [Volumn:3 ] [Number:1] [Pages:57] [Pages No:14-24][No of Hits : 5524]


ABSTRACT

Objectives: An effective postoperative analgesia following total knee arthroplasty (TKA) would shorten the rehabilitation period and improve patient satisfaction. The primary objective of the present study is to test the hypothesis that intraoperative multimodal cocktail injection can significantly reduce the consumption of analgesics and duration of time required to perform straight-leg raise, and improve range of motion (ROM) and patient satisfaction rate following TKA.

Materials and methods: A total of 126 osteoarthritic knees in patients with a mean age of 68 years (58–80 years) scheduled for primary TKA were prospectively randomized into three groups. Patients in all three groups received the same anesthesia and postprocedure pain control and rehabilitation protocol. The assessor was blind with regard to multimodal cocktail injection for the duration of study. Assessment was done preoperatively at 1, 2, 3, and 4 postoperative days, and at 1, 2, and 3 months postoperatively. The primary outcome was function measured with Western Ontario and McMaster Universities Arthritis Index. Pain and patient satisfaction rate were established using visual analog scale and Likert scale respectively. Consumption of analgesic during the postoperative days (1–4 days), hospital stay, and ROM were recorded and evaluated. Outcome measures were critically analyzed. The level of significance was set at <0.05.

Results: Pain, functional scores, and satisfaction rates were significantly better in cocktail group than in the control group (p < 0.05). Consumption of nonsteroidal anti-inflammatory drugs was significantly lower in groups with multimodal cocktail injection than in the control group (p < 0.05). Mean follow-up time was 3 months with no patient lost to follow-up. No complications related to the infiltration of the local anesthetic and/or steroids were observed.

Conclusion: Multimodal cocktail injection offered improved postoperative pain control, thus facilitating early rehabilitation.

Keywords: Likert scale, Nonsteroidal anti-inflammatory drugs, Total knee arthroplasty, Visual analog scale, Western Ontario and McMaster Universities Arthritis Index.

How to cite this article: Shah VI, Upadhyay S, Shah K, Sheth AN, Kshatriya A, Saini D. Multimodal Cocktail Injection relieves Postoperative Pain and improves Early Rehabilitation following Total Knee Replacement: A Prospective, Blinded and Randomized Study. J Recent Adv Pain 2017;3(1):14-24.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Gautam Das, Samarjit Dey, Ravi S Sharma, Kanchan Sharma, Debjyoti Dutta, Chinmoy Roy

Rami Communicans Block Prior to Transforaminal Endoscopic Discectomy relieves Procedure Pain Significantly and adds Safety: A Case–control Study

[Year:2017] [Month:May-August] [Volumn:3 ] [Number:2] [Pages:51] [Pages No:90-95][No of Hits : 1351]


ABSTRACT

Background: The ability to isolate and visualize the “pain” generators in the foramen and treat persistent pain by visualizing inflammation and compression of nerves serves as the basis for transforaminal endoscopic (TFE) surgery.It provides a least invasive basic access to the disc. One of the important steps is the insertion of dilator and working sleeve followed by introduction of endoscope. Often this step is carried out with the help of a hammer, which is agonizing for the patients undergoing surgery. This study aims at analyzing the efficacy of the rami communicans nerve block in reducing the intraoperative pain in patients undergoing TFE discectomy.

Materials and methods: A total of 48 patients undergoing TFE discectomy were assigned into two groups. Group I (case, n = 27) received rami communicans block prior to endoscopic discectomy a nd f or g roup I I (control, n = 2 1), n o r ami c ommunicans block was given. Under all aseptic precautions, the rami communicans block was given to group I patients after identification of corresponding level. After proper placement of block, lumbar TFE discectomy was performed using the “insideout” approach. Pain was assessed using numerical rating scale (NRS) at different time intervals. Statistical analysis was carried out using independent Student’s t-test, chi-squared test, and Mann-Whitney U test.

Results: While comparing NRS, group I showed significantly lower NRS when compared with group II and it was highly significant (p-value < 0.0001). The need for rescue analgesia was also compared and this difference was also found to be highly significant (p-value < 0.0001).

Conclusion: The rami communicans block is highly effective in reducing the intraoperative pain in patients undergoing TFE discectomy and thus, reduces the total dose of anesthetics and analgesics intraoperatively.

Keywords: Inside-out, Rami communicans block, Transforaminal endoscopic discectomy.

How to cite this article: Das G, Dey S, Sharma RS, Sharma K, Dutta D, Roy C. Rami Communicans Block Prior to Transforaminal Endoscopic Discectomy relieves Procedure Pain Significantly and adds Safety: A Case-control Study. J Recent Adv Pain 2017;3(2):90-95.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Nuruzzaman Khandaker, Syed M Ahmed, Israt Hasan, Amitav Banik

Neck Pain in a Young Girl: A Pott’s Disease Case Study

[Year:2017] [Month:May-August] [Volumn:3 ] [Number:2] [Pages:51] [Pages No:81-84][No of Hits : 1012]


ABSTRACT

Cervical spinal tuberculosis (TB) is a rare variant of extrapulmonary TB with a high complication rate. Tuberculosis of the cervical spine is reported in about 6 to 9% of all cases of spinal TB. Early diagnosis and treatment of spinal TB is essential in order to prevent neural deficit. Management strategies for spinal TB range from ambulatory chemotherapy to radical surgical debridement with fusion. We present a case of an Old Dhaka citizen, 15-year-old girl, who was admitted to the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, because of a severe painful restriction of neck movement with torticollis to left for 5 months, neck stiffness, and restriction of neck movement in all planes of cervical spine. On physical examination, the girl was subfebrile, mildly anemic, and tenderness present over the upper part of cervical spine. Head was deviated toward left side. Neurological examination revealed no focal motor weakness. The roentgenograms of chest, pelvis, and cranium were without pathological changes. Abdominal ultrasonography was normal. A magnetic resonance imaging scan revealed marrow contusion in body of C2 with odontoid process, adjacent anterior and left side of prevertebral soft tissue swelling with small collection at C2 level, and scoliosis with straightening of cervical spine. Histopathological examination of the removed material showed typical granulomatous inflammation with characteristic infiltrate of lymphocytes, epithelioid macrophages, and Langhans-type multinucleated giant cells.

Keywords: Cervical spine, Neck pain, Pott’s disease.

How to cite this article: Khandaker N, Ahmed SM, Hasan I, Banik A. Neck Pain in a Young Girl: A Pott’s Disease Case Study. J Recent Adv Pain 2017;3(2):81-84.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Tintu Xavier, Lekha Viswanath

Effect of Music Therapy on Labor Pain among Women in Active Labor admitted in Tertiary Care Hospital, Kochi City

[Year:2017] [Month:January-April] [Volumn:3 ] [Number:1] [Pages:57] [Pages No:3-6][No of Hits : 952]


ABSTRACT

Introduction: The pain associated with the birth of baby is perceived as severe, unpleasant, and traumatizing by women. It is an individualized phenomenon with both sensory and emotional elements. Labor pain arises from distension of the lower uterine segment and cervical dilatation. Anxiety and pain are closely interrelated. Providing comfort to women in labor is still a challenge for the nurse midwives. The present study intends to assess the effect of music therapy on labor pain and anxiety among women in first stage of labor in a tertiary care hospital in Kochi.

Materials and methods: Quasi-experimental pretest– posttest control group design was used for the study. The sample consisted of 40 women in active stage of labor, with cervical dilatation of 4 to 7 cm. The first 20 women were allotted to control group and the next 20 to experimental group in order to avoid contamination. Background information was collected using semi-structured interview and record review. Visual analog scale was used to measure pain and anxiety. After the pretest measurement of pain and anxiety the women in the experimental group were given music therapy for 30 minutes using headset. The posttest was done at the 30th and 60th minute after the pretest.

Results: The mean posttest pain score of the experimental group (7.9) was significantly lower than the posttest score of the control group at the 30th minute (5.75 ± 0.44 vs 8.55 ± 0.51, p < 0.001) and 60th minute (7.9 ± 0.45 vs 8.7 ± 0.47, p < 0.001). No difference was observed in uterine contraction between the groups. The mean anxiety score of the experimental group was lower than the control group (p < 0.001).

Conclusion: The result of the present study concludes that music therapy is effective in reducing pain and anxiety of women in labor without affecting uterine contractions. So music can be used as a nonpharmacological pain management measure for providing comfort during labor.

Keywords: Labor pain and anxiety, Music therapy, Nonpharmacological pain management.

How to cite this article: Xavier T, Viswanath L. Effect of Music Therapy on Labor Pain among Women in Active Labor admitted in Tertiary Care Hospital, Kochi City. J Recent Adv Pain 2017;3(1):3-6.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Ashok Jadon, Priyanka Jain, Mayur Motaka

Serratus Anterior Plane Block failed to relieve Pain in Multiple Fractured Ribs: Report of Two Cases

[Year:2017] [Month:January-April] [Volumn:3 ] [Number:1] [Pages:57] [Pages No:50-53][No of Hits : 813]


ABSTRACT

The serratus anterior plane block (SAPB) has been used successfully to treat pain of multiple fractured ribs (MFRs). We report two cases of MFRs where pain relief was not satisfactory with SAPB and, therefore, thoracic epidural was used for further management of pain. We have discussed the possibility of failure and suggested that if fracture is in the posterior part of the ribs, then thoracic epidural or paravertebral should be preferred over SAPB.

Keywords: Chest injury, Fracture rib, Regional analgesia, Serratus anterior plane block, Ultrasound-guided blocks.

How to cite this article: Jadon A, Jain P, Motaka M. Serratus Anterior Plane Block failed to relieve Pain in Multiple Fractured Ribs: Report of Two Cases. J Recent Adv Pain 2017;3(1):50-53.

Source of support: Nil

Conflict of interest: None


 
PRACTITIONER'S SECTION
Pavana B Nagaraj, Gautam Das, Palak Chavda

Caudal Epidural Steroid Injection in Pain Management

[Year:2017] [Month:May-August] [Volumn:3 ] [Number:2] [Pages:51] [Pages No:96-98][No of Hits : 803]


ABSTRACT

Caudal epidural steroid injection is one of the most commonly performed procedures in pain clinic. It is effective and technically easy to perform. The rate of complications is higher when attempted blind. Fluoroscopically guided caudal approach is recommended and increases the efficacy and safety profile for depo steroid administration. This article reviews the anatomy of caudal space, technique of fluoroscopic-guided caudal steroid injection, and its advantages and disadvantages.

Keywords: Caudal, Epidural, Fluoroscopy

How to cite this article: Das G, Nagaraj PB, Chavda P. Caudal Epidural Steroid Injection in Pain Management. J Recent Adv Pain 2017;3(2):96-98.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Shantanu Mallick

Radiofrequency-assisted minimally Invasive Manual Lumbar Discectomy using Disc-Fx System: Outcome of Nine Cases

[Year:2017] [Month:January-April] [Volumn:3 ] [Number:1] [Pages:57] [Pages No:7-13][No of Hits : 786]


ABSTRACT

Introduction: The preferred treatments for discogenic axial or radiating lower back pain are controversial. Available treatments are medication, physical therapy, epidural steroid, percutaneous endoscopic discectomy, open surgical discectomy, etc. A radiofrequency-assisted minimally invasive lumbar manual discectomy with nucleus ablation and annulus modulation by Elliquence’s “Disc-Fx system” has been successfully used to treat nine patients for their low back pain.

Materials and methods: Nine patients (35–55 years/M:F = 2:7) with lower back pain radiating to leg that failed to improve with conservative managements for more than 6 weeks were assigned. The magnetic resonance imaging shows moderate size of single contained disc herniation at L4-5 or L5-S1 with minimal degenerative changes (preserved disc height). All Disc-Fx procedures were performed in a day care basis under fluoroscopic guidance under local anesthesia with or without minimal sedation. Evaluation with a global assessment scale at 6 weeks, 3- and 6-months interval was done.

Results: All the patients underwent Disc-Fx treatment at one level, either L4-5 or L5-S1, after confirming the diagnosis with preoperative provocative discography. Mean operation time was 60 to 90 minutes, mean postoperative recovery time was 60 to 90 minutes, and blood loss was minimal. Mean return to normal day-to-day activities was 7 days. The numerical rating scale score was significantly lower than before operation. No complication occurred except in one patient, who was not satisfied symptomatically (contacted on phone), but did not come for follow-up after procedure till date.

Conclusion: Disc-Fx is an effective treatment option in discogenic pain and degenerative moderate contained disc prolapsed without bony and soft tissue stenosis. This minimally invasive approach does have advantages of no bony instability and minimal scarring/adhesion of epidural space, and thus, reduces postoperative complications to a great extent. It reduces hospital stay and leads to faster rehabilitation and early return to work, which reduces the cost of the treatment.

Keywords: Annulus modulation, Disc herniation, Disc-Fx, Discogenic pain, Low back pain, Manual discectomy, Nucleus ablation.

How to cite this article: Mallick S. Radiofrequency-assisted minimally Invasive Manual Lumbar Discectomy using Disc-Fx System: Outcome of Nine Cases. J Recent Adv Pain 2017;3(1):7-13.

Source of support: Nil

Conflict of interest: None


 
PRACTITIONER’S SECTION
Krishna Poddar, Rachit Gulati

Lumbar Facet Joint Interventions

[Year:2017] [Month:January-April] [Volumn:3 ] [Number:1] [Pages:57] [Pages No:36-40][No of Hits : 777]


ABSTRACT

Facet joints or zygapophyseal joints are paired synovial joints in the vertebrae that are commonly affected by degenerative changes that cause pain and disability. It is one of the most prevalent causes of low back pain and is more commonly seen in older population. Facet joint interventions may involve an intra-articular joint injection and medial branch block. Both of them are relatively simple and straightforward procedures best performed under fluoroscopy for guidance to properly target and place the needle.

Keywords: Facet joint, Intra-articular injection, Medial branch, Radiofrequency ablation.

How to cite this article: Poddar K, Gulati R. Lumbar Facet Joint Interventions. J Recent Adv Pain 2017;3(1):36-40.

Source of support: Nil

Conflict of interest: None


 
EDITORIAL
Annu Navani

Inevitable Evolution: How Technology has transformed Physician–Patient Partnership?

[Year:2017] [Month:January-April] [Volumn:3 ] [Number:1] [Pages:57] [Pages No:1-2][No of Hits : 765]


ABSTRACT

The history of medicine is as old as civilization. The Hippocratic oath written in Greece in the fifth century BCE is still considered the basic foundation of medical ethics. Early medical traditions started in Babylon, China, Egypt, and India, whereas Italy led the way in systematic training of physicians through universities around the thirteenth century.1


 
ORIGINAL ARTICLE
VY Apte, Pradnya M Bhalerao, MA Lokapur, RP Sancheiti, KV Kelkar

Comparison of Analgesic Effects of Intravenous Nalbuphine and Pentazocine in Patients posted for Short-duration Surgeries: A Prospective Randomized Double-blinded Study

[Year:2017] [Month:May-August] [Volumn:3 ] [Number:2] [Pages:51] [Pages No:77-80][No of Hits : 719]


ABSTRACT

Background and objectives: Postoperative pain influences the long-term outcome of the patient in a big way. We performed a randomized prospective double-blind study to evaluate the effects of intravenous (IV) nalbuphine and compared it with IV pentazocine. The primary objective was to compare the duration of analgesia of IV nalbuphine and IV pentazocine and the secondary objective was to study the side-effect profile.

Materials and methods: Sixty American Society of Anesthesiologists (ASA) physical status I and II patients undergoing short-duration surgery under general anesthesia were randomly allocated in two groups of 30 each to receive either nalbuphine (group I) or pentazocine (group II) IV. The duration of postoperative analgesia, need for rescue analgesia, and side effects if any were monitored. Two-sample t-tests were used to investigate and model the impact of various parameters like duration of analgesia and side-effect profile.

Results: Duration of analgesia in group I (7.43 ± 1.63 hours) was significantly prolonged as compared with group II (4.73 ± 1.62 hours). Statistical significance (p < 0.05) was noted. Significance was not noted between the two groups when sedation score was compared.

Conclusion: Intravenous nalbuphine is superior to IV pentazocine in providing analgesia and causes less sedation.

Keywords: Nalbuphine, Pentazocine, Postoperative analgesia.

How to cite this article: Apte VY, Bhalerao PM, Lokapur MA, Sancheiti RP, Kelkar KV. Comparison of Analgesic Effects of Intravenous Nalbuphine and Pentazocine in Patients posted for Short-duration Surgeries: A Prospective Randomized Doubleblinded Study. J Recent Adv Pain 2017;3(2):77-80.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Dipasri Bhattacharya

Ultrasound vs Fluoroscopy in Pain Intervention

[Year:2017] [Month:January-April] [Volumn:3 ] [Number:1] [Pages:57] [Pages No:46-49][No of Hits : 685]


ABSTRACT

Fluoroscopy-guided intervention is the gold standard for chronic pain management. Most of the pain physicians are very comfortable with fluoroscopy-guided procedures. Ultrasonography (USG) is slowly emerging with satisfactory results in the field of chronic pain management. Both have its advantages and disadvantages. Most of the articles are in favor of fluoroscopy for spine procedures, whereas USG is unique in regional nerve block procedures. More studies are required to prove the superiority of one technique over the other.

Keywords: Fluoroscopy, Pain intervention, Ultrasound.

How to cite this article: Bhattacharya D. Ultrasound vs Fluoroscopy in Pain Intervention. J Recent Adv Pain 2017;3(1):46-49.

Source of support: Nil

Conflict of interest: None


 
EDITORIAL
Mayank Chansoria

Scope of Pain Clinics in India

[Year:2017] [Month:May-August] [Volumn:3 ] [Number:2] [Pages:51] [Pages No:59-60][No of Hits : 625]


ABSTRACT

One of the revolutionary disciplines emerging in the field of medicine in India in recent times is Pain Medicine, though developed countries like the United States have put a special impetus on its practice and recognized it as a separate specialty since the last century.

How to cite this article: Chansoria M. Scope of Pain Clinics in India. J Recent Adv Pain 2017;3(2):59-60.

Source of support: Nil

Conflict of interest: None


 
BRIEF COMMUNICATION
Mousumi Datta, Gautam Das

D3 Marker: A New Instrument for C-arm-guided Pain Procedures

[Year:2017] [Month:January-April] [Volumn:3 ] [Number:1] [Pages:57] [Pages No:56-57][No of Hits : 576]


ABSTRACT

To identify the needle entry point in a C-arm-guided pain procedure a metal marker is used. D3 Marker is a new metal marker which is designed to identify the needle entry point with less number of fluoroscopic shots. In addition, it can also be used to measure distance from 1 to 18 cm approximately.

Keywords: Marker for C-arm procedure, Metal marker, Needle guidance device.

How to cite this article: Datta M, Das G. D3 Marker: A New Instrument for C-arm-guided Pain Procedures. J Recent Adv Pain 2017;3(1):56-57.

Source of support: Nil

Conflict of interest: None


 
BRIEF COMMUNICATION
Sunny Malik, Arun Puri

Genicular Branch Radiofrequency Ablation: A New Modality for Pain Relief in Osteoarthritis knee

[Year:2017] [Month:September-December] [Volumn:3 ] [Number:3] [Pages:41] [Pages No:140-141][No of Hits : 571]


ABSTRACT

Chronic knee pain usually occurs in the elderly due to knee osteoarthritis. Many patients are not suitable candidates for replacement surgeries. For such patients who are not willing for surgery or have a multitude of co-morbidities, there are conservative options available including joint injections. Genicular nerve block (radiofrequency ablation) is a recently developed treatment modality which adds a good benefit in terms of pain relief in cases with osteoarthritis (OA) knee. The procedure is quite simple to do and can be done as an outpatient department (OPD) based procedure with the use of ultrasound.

Keywords: Genicular nerve, Osteoarthritis, Radiofrequency.

How to cite this article: Malik S, Puri A. Genicular Branch Radiofrequency Ablation: A New Modality for Pain Relief in Osteoarthritis Knee. J Recent Adv Pain 2017;3(3):140-141.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Dileep Gupta, Vandana Mangal, Gaurav Sharma, Amit Kulshestha, Poonam Kalra

Efficacy of Magnesium Sulfate as Adjuvant to Ropivacaine 0.4% for Supraclavicular Brachial Plexus Block in Patients undergoing Upper Limb Surgery: A Randomized Controlled Trial

[Year:2017] [Month:May-August] [Volumn:3 ] [Number:2] [Pages:51] [Pages No:85-89][No of Hits : 552]


ABSTRACT

Objectives: To prolong the duration of brachial plexus block, different adjuvants have been used. We evaluated the effect of adding magnesium sulfate to local anesthetic ropivacaine 0.4% for institution of supraclavicular brachia plexus block. Onset of sensory and motor block, duration of motor block, and rescue analgesia were observed.

Materials and methods: Total 120 patients (20-50 years) scheduled for elective surgeries of upper limb under supraclavicular brachial plexus block were randomized into two groups. Group I received 24 mL 0.5% ropivacaine (120 mg) + 6.0 mL normal saline (NS) to make total volume of 30 mL. Group II received 24 mL 0.5% ropivacaine (120 mg) + 150 mg magnesium sulfate + 5.5 mL NS to make total volume of 30 mL.

Results: Onset of sensory block in group I was 16.63 ± 2.79 min and in group II was 17.33 ± 2.25 min (statistically not significant, p > 0.05). Onset of motor block in group I was 18.63 ± 2.79 min and in group II was 19.76 ± 2.18 min (statistically significant, p < 0.05). The duration of motor block was significantly longer in group II; 322.00 ± 81.35 min than group I; 260.25 ± 66.79 min (p < 0.05). Similarly, time of rescue analgesia was significantly prolonged in group II; 491 ± 100.22 min than group I; 377.67 ± 73.31 min (p < 0.05).

Conclusion: From our study, we concluded that the addition of 150 mg magnesium sulfate as adjuvant to 30 mL of 0.4% ropivacaine in comparison to 30 mL of 0.4% ropivacaine provides longer duration of analgesia. Although the onset of sensory block is not affected, onset of motor block is delayed. Motor block lasts for longer duration.

Keywords: Magnesium, Ropivacaine, Supraclavicular block.

How to cite this article: Gupta D, Mangal V, Sharma G, Kulshestha A, Kalra P. Efficacy of Magnesium Sulfate as Adjuvant to Ropivacaine 0.4% for Supraclavicular Brachial Plexus Block in Patients undergoing Upper Limb Surgery: A Randomized Controlled Trial. J Recent Adv Pain 2017;3(2):85-89.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Rita Upadhyay, Mayank Chansoria, Mamta Mahobia, Neha Vyas

Headache, Primary Headaches and Their Treatment

[Year:2017] [Month:May-August] [Volumn:3 ] [Number:2] [Pages:51] [Pages No:99-104][No of Hits : 544]


ABSTRACT

Introduction: Headache is a symptom which may be associated with a variety of clinical conditions whether the underlying disorder be organic, psychologic or psychophysiologic. Headache disorders can be classified as primary , secondary and specific types of headache.
Patients usually present with primary headache in primary health care settings . More than one type of primary headache may be present in one patient and each headache has to be treated separately. Migraine is the most common severe primary headache disorder.

Conclusion: Every presentation of headache requires care to exclude organic disease, and every presentation provides the opportunity to relieve suffering.

Keywords: Headache, Migraine, Prophylactic therapy.

How to cite this article: Upadhyay R, Chansoria M, Mahobia M, Vyas N. Headache, Primary Headaches and Their Treatment. J Recent Adv Pain 2017;3(2):99-104.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Neelesh K Mathankar, Mayank Chansoria

Prolotherapy: From Glorious Past to Promising Future

[Year:2017] [Month:January-April] [Volumn:3 ] [Number:1] [Pages:57] [Pages No:41-45][No of Hits : 534]


ABSTRACT

Prolotherapy, a nonsurgical regenerative injection therapy, is becoming increasingly popular among the pain physicians as well as patients. The current theory suggests that the prolotherapy mimics the natural healing process of the body by initiating a local inflammatory cascade, which triggers the release of growth factors and collagen deposition. Although the clinical literature on prolotherapy had been published since last 80 years, the quality, number, and research have increased since the 1990s. The growing body of evidences suggests its use in osteoarthritis, low back pain, and tendinopathies. With recent advances in stem cell therapy and regenerative medicine, prolotherapy will play a greater role in the treatment of chronic degenerative conditions and sports injuries.

Keywords: Chronic pain, Osteoarthritis, Prolotherapy, Regenerative injection therapy, Stem-cell therapy, Tendinopathy.

How to cite this article: Mathankar NK, Chansoria M. Prolotherapy: From Glorious Past to Promising Future. J Recent Adv Pain 2017;3(1):41-45.

Source of support: Nil

Conflict of interest: None


 
PRACTITIONER’S SECTION
Pankaj Surange

S1 Transforaminal: Technique and Troubleshooting

[Year:2016] [Month:January-April] [Volumn:2 ] [Number:1] [Pages:36] [Pages No:15-17][No of Hits : 4509]


ABSTRACT

Role of interventions in pain medicine is one of the important aspects. Even if we diagnose the condition correctly but if we are not familiar with the interventions and their troubleshooting we may land up in a problem. Every patient is different; every procedure is a challenge to the pain physician. S1 transforaminal is such a procedure which every pain physician should know including its troubleshooting. We must be through with the technical aspects of the interventions .In this article of practitioner’s corner, the technique and troubleshooting is being discussed to increase our clinical and intervention accuracy.

Keywords: Epidural steroid injection, S1 foramina, Transforaminal.

How to cite this article: Surange P. S1 Transforaminal: Technique and Troubleshooting. J Recent Adv Pain 2016;2(1): 15-17.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Rammurthy Kulkarni, RM Ramyashree

Interspinous Ligament as a Pain Generator

[Year:2016] [Month:May-August] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:54-55][No of Hits : 2787]


ABSTRACT

Introduction: Interspinous ligament is an uncommon but potential pain generator in the spinal column that can give rise to chronic low backache. Interspinous ligament sprain is difficult to diagnose with radiologic imaging, such as X-ray, and magnetic resonance imaging. Only meticulous history and diagnostic block help in making a proper diagnosis. This case report describes a case of interspinous ligament sprain in a young male patient who presented with a history of chronic low back pain. His imaging studies revealed no abnormalities and the diagnostic local anesthetic infiltration confirmed the diagnosis.

Keywords: Interspinous ligament, Low back pain, Pain generator.

How to cite this article: Kulkarni R, Ramyashree RM. Interspinous Ligament as a Pain Generator. J Recent Adv Pain 2016;2(2):54-55.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Sunny Malik, Gautam Das, Monika Dabgotra, Mousumi Datta

Coccydynia with Central Sensitization plays an Important Role as Pain Generator

[Year:2016] [Month:May-August] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:62-64][No of Hits : 2418]


ABSTRACT

Introduction: Reported is a case of “idiopathic coccydynia” with chronic pain which was refractory to conservative, medical, and interventional treatment. A diagnosis of central sensitization with coccydynia was made, and the patient responded very well to desensitization program with lignocaine and clonidine mixture. Central sensitization has proven its identity in fibromyalgia, chronic low back pain, and arthritis. But reports in coccydynia are lacking. This case report highlights the role and successful treatment of central sensitization in chronic “idiopathic coccydynia.”

Keywords: Central sensitization, Coccydynia, Hyperalgesia.

How to cite this article: Malik S, Das G, Dabgotra M, Datta M. Coccydynia with Central Sensitization plays an Important Role as Pain Generator. J Recent Adv Pain 2016;2(2):62-64.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Rammurthy Kulkarni

Ultrasound-guided Stellate Ganglion Block

[Year:2016] [Month:January-April] [Volumn:2 ] [Number:1] [Pages:36] [Pages No:22-24][No of Hits : 1538]


ABSTRACT

Ultrasound has emerged as an important and inseparable tool in the field of anesthesiology and pain management. Its use is increasing everyday to aid in regional anesthesia and in chronic pain interventions. It is replacing fluoroscopy to guide many chronic pain interventions, especially the sympathetic blocks like stellate ganglion block, celiac plexus block, superior hypogastric plexus block, ganglion impar block, etc. Stellate ganglion block is used in the treatment of wide variety of chronic painful conditions of head, neck and the upper limb. Hence, it is one of the commonest procedures in chronic pain management. Stellate ganglion block is commonly performed under fluoroscopy guidance. Use of ultrasound during this procedure has shown to be as effective as the fluoroscopyguided technique, more safe than fluoroscopy and can avoid radiation exposure. In this article, we have described the merits and demerits of the ultrasound-guided stellate ganglion blockade as compared to the fluoroscopy.

Keywords: Fluoroscopy, Stellate ganglion, Ultrasound.

How to cite this article: Kulkarni R. Ultrasound-guided Stellate Ganglion Block. J Recent Adv Pain 2016;2(1):22-24.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Deepika Soni, Gautam Das, Mousumi Datta

Atypical Presentation of Cervical Facet Arthropathy: Neck Pain along with Numbness and Weakness of Upper Limb

[Year:2016] [Month:September-December] [Volumn:2 ] [Number:3] [Pages:46] [Pages No:106-108][No of Hits : 1269]


ABSTRACT

Most of the cervical facet arthropathy cases present with neck pain with referred pain in the head and upper extremities. Tenderness to palpation over the facet joints or paraspinal muscles, accentuation of pain with cervical extension or rotation, and the absence of any neurologic deficits are the usual findings. Radicular symptoms are seldom associated with cervical facet arthropathy.
We report a case of a 23-year-old female patient presented with chief complaints of neck pain radiating to entire right upper limb with weakness and numbness of that limb. Physical examination revealed limitation of range of motion of neck, painful extension and lateral rotation of neck, tenderness over C4-5 and C5-6 facet joints, and tenderness over right trapezius muscle. Weakness and numbness over hand was also present, though electromyography and nerve conduction velocity study was normal in both upper limbs. Magnetic resonance imaging (MRI) cervical spine was suggestive of mild posterior disk osteophytes at C4-5, C5-6, and C6-7 causing grade 1 cervical canal stenosis and cervical spondylosis with degenerative disk disease. Trigger point injections were given in trapezius and scalene muscle. There was not much improvement. Considering facet arthropathy as a differential diagnosis, diagnostic median branch block at C4, C5, and C6 level was done. It was positive with more than 80% pain relief. Later on, radiofrequency (RF) ablation of C4, C5, and C6 median branch was done. Pain was reduced significantly with improvement of other symptoms like weakness and numbness.

Keywords: Cervical facet arthropathy, Numbness, Pain, Weakness.

How to cite this article: Soni D, Das G, Datta M. Atypical Presentation of Cervical Facet Arthropathy: Neck Pain along with Numbness and Weakness of Upper Limb. J Recent Adv Pain 2016;2(3):106-108.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Mayank Chansoria, Sachin Upadhyay, Sheetal Panwar, Piyush Shivhare, Neha Vyas

Comparative Efficacy of Intraarticular Injection of Combination of Ozone and Steroid and Ozone alone in Patients with Primary Knee Osteoarthritis: A Prospective and Randomized Clinical Analysis

[Year:2016] [Month:January-April] [Volumn:2 ] [Number:1] [Pages:36] [Pages No:11-14][No of Hits : 1099]


ABSTRACT

Background: Osteoarthritis (OA) is the most prevalent chronic degenerative joint disorder worldwide and is associated with significant pain, disability and economic impact on society. The primary objective of the present research is to validate the hypothesis that combination of intraarticular injection of ozone and steroid has better outcome than using ozone alone in patients with primary knee OA.

Materials and methods: Cohort comprises of 80 patients of American Society of Anesthesiologists (ASA) I and II between age 45 and 70 years of either sex with primary knee OA with radiographic evidence (grade 0, I, and II; Lawrence and Kellgren radiological criteria) of severity of knee joint. The patients were randomized to receive single intraarticular injection of either ozone alone or combination of ozone with steroid. All patients were assessed using Western Ontario and McMaster University Osteoarthritis (WOMAC) index, and the visual analog pain scale (VAS) at 1, 3, and 6 months of follow-up. Statistical Package for the Social Science (SPSS) for Windows software was used for data management and statistical analysis. The level of significance was set at 0.05 for all statistical tests.

Result: Both the group treated with the combination of ozone and steroid and the group treated with ozone alone demonstrated improvements from baseline parameters. At 1 month patients in both group showed significant improvement in VAS and WOMAC (p < 0.05). Group treated with combination of ozone and steroid showed significant difference (p < 0.05) with respect to WOMAC, or VAS results at the end of 6 months of follow-up.

Conclusion: Ozone treatment was highly effective in relieving pain and improving functional outcome in patients with primary knee OA. Significant differences were detected between patients treated with intraarticular injections combination of ozone and steroid and those treated with the ozone alone with respect to pain relief or function at 6 months of follow-up.

Keywords: Intraarticular injections, Osteoarthritis, Ozone, Steroid.

How to cite this article: Chansoria M, Upadhyay S, Panwar S, Shivhare P, Vyas N. Comparative Efficacy of Intraarticular Injection of Combination of Ozone and Steroid and Ozone alone in Patients with Primary Knee Osteoarthritis: A Prospective, Randomized Clinical Analysis. J Recent Adv Pain 2016;2(1):11-14.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Kawsar Sardar, Md A Rashid, Mahmudur R Khandoker, ANMN Khan

Anticonvulsants and Antidepressants in Chronic Pain Management

[Year:2016] [Month:September-December] [Volumn:2 ] [Number:3] [Pages:46] [Pages No:90-93][No of Hits : 979]


ABSTRACT

Epidemiological studies have found that 10.1 to 55.2% of people in various countries have chronic pain. Various medicines are prescribed, depending on whether the pain originates from tissue damage or is neuropathic. Evidence suggests that chronic pain from tissue inflammation or damage as in rheumatoid arthritis and cancer pain is best treated with opioids and anti-inflammatory drugs, while for neuropathic pain where pain is caused by a damaged or dysfunctional nervous system other drugs may be more effective. Chronic pain is a global concern affecting people from all walks of life. As the epidemic of opioid misuse continues to grow, the need for balanced, multimodal approaches to the treatment of pain syndromes has become more apparent. These include medications which, though originally designed to treat other pathologies, have demonstrated benefits in the treatment of chronic pain. This article is a review of the pharmacodynamics of various classes of antidepressants and anticonvulsants and the effects of these drugs on pain signaling and perception. Finally, recommendations for the use of such drugs in the patient with chronic pain are discussed.

Keywords: Anticonvulsants, Antidepressants, Chronic pain.

How to cite this article: Sardar K, Rashid MA, Khandoker MR, Khan ANMN. Anticonvulsants and Antidepressants in Chronic Pain Management. J Recent Adv Pain 2016;2(3):90-93.

Source of support: Nil.

Conflict of interest: None.


 
ORIGINAL ARTICLE
Shweta Jain, Gaurav Sharma, Usha Bafna, Dilip Jain, Sunita Meena, Pranav Jetley

A Comparative Study of Intrathecal Fentanyl and Dexmedetomidine as Adjuvants to Hyperbaric Levobupivacaine 0.5% and Hyperbaric Levobupivacaine 0.5% Alone in Infraumbilical Surgeries

[Year:2016] [Month:May-August] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:44-48][No of Hits : 894]


ABSTRACT

Introduction: Spinal anesthesia is the most common approach used for lower abdominal surgeries. Levobupivacaine 0.5% and racemic bupivacaine 0.5% are equally effective in spinal anesthesia. Dexmedetomidine (a highly selective alpha-2 adrenergic agonist) and fentanyl (short-acting synthetic opioid) are effective intrathecal adjuvants. The aim of our study was to evaluate onset and duration of sensory and motor block, duration of postoperative analgesia, and side effects on addition of dexmedetomidine and fentanyl as adjuvants to hyperbaric 0.5% levobupivacaine along with the control group.

Materials and methods: Ninety patients of American Society of Anesthesiologists (ASA) grade I/II undergoing infraumbilical surgery were studied in a prospective, double blind, controlled study. Levobupivacaine was made hyperbaric by adding 1 mL of 25% dextrose to 12.5 mg levobupivacaine. Patients were randomly allocated to receive either 12.5 mg hyperbaric levobupivacaine + normal saline (group A, n = 30) or 12.5 mg hyperbaric levobupivacaine + 25 µg fentanyl (group B, n = 30) or 12.5 mg hyperbaric levobupivacaine + 5 µg dexmedetomidine (group C, n = 30) intrathecally.

Results: Patients in the dexmedetomidine group had significantly longer sensory and motor block time than patients in the fentanyl and control groups. Mean time of sensory regression to S1 was 161.2 ± 14.6, 180.3 ± 6.2, and 472.5 ± 8.7 minutes in groups A to C respectively (p < 0.0001). Duration of analgesia was prolonged to 259.4 ± 12.8 minutes in group C as compared with 114.0 ± 14.3 and 161.8 ± 8.5 minutes in the control and fentanyl group respectively (p < 0.0001).

Conclusion: Intrathecal 5 µg dexmedetomidine seems to be an attractive alternative to 25 µg fentanyl as adjuvant to 0.5% hyperbaric levobupivacaine in spinal anesthesia. It is associated with prolonged motor and sensory block and provides good quality of intraoperative analgesia and extended duration of postoperative analgesia as compared with fentanyl.

Keywords: Dexmedetomidine, Fentanyl, Levobupivacaine, Spinal anesthesia.

How to cite this article: Jain S, Sharma G, Bafna U, Jain D, Meena S, Jetley P. A Comparative Study of Intrathecal Fentanyl and Dexmedetomidine as Adjuvants to Hyperbaric Levobupivacaine 0.5% and Hyperbaric Levobupivacaine 0.5% Alone in Infraumbilical Surgeries. J Recent Adv Pain 2016;2(2):44-48.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Sarika S Naik, Lokesh Kumar, Surjya K Mohanty, Sanjay Banakal, L Channakeshava

Anesthesia in Awake Craniotomy: Advantages of Dexmedetomidine Infusion over Conventional Methods

[Year:2016] [Month:May-August] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:65-68][No of Hits : 867]


ABSTRACT

Background/objectives: Dexmedetomidine, an α 2 agonist used as infusion with scalp block, is a good adjuvant with analgesic, anxiolytic, and sedative effect with minimal effects on hemodynamic changes and respiration depression. In this study, we report the efficacy of dexmeditomidine for awake craniotomy.

Materials and methods: Three American Society of Anesthesiologists grade 2 patients were posted for tumor resection under awake craniotomy. Scalp block was given with local anesthetic and dexmedetomidine bolus dose of 1 µg/kg/hr followed by 0.2 to 0.4 µg/kg/hr. The patient±s speech was monitored by oral questionnaire, motor strength by hand squeezing, and sedation by modified Ramsay Hunt Score.

Results: Bolus dose of 1 µg/kg over 20 minutes infusion of 0.2 to 0.4 µg/kg/hr is a good adjuvant with scalp block with minimal hemodynamic changes.

Conclusion: Dexmedetomidine is a useful adjuvant during awake craniotomy for tumor resection. It has minimal effect on hemodynamics and respiratory system. It can be used in procedures where cooperation of the patient is required intraoperatively.

Keywords: Awake craniotomy, Dexmedetomidine, Neuroanesthesia, Scalp block.

How to cite this article: Naik SS, Kumar L, Mohanty SK, Banakal S, Channakeshava L. Anesthesia in Awake Craniotomy: Advantages of Dexmedetomidine Infusion over Conventional Methods. J Recent Adv Pain 2016;2(2):65-68.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Peeyush Shivhare, Mayank Chansoria, Amit Vyas, Arti Dalal

Single Injection Combined Femoral Sciatic Nerve Block in Lower Limb Orthopedic Surgery in a High-risk Patient

[Year:2016] [Month:September-December] [Volumn:2 ] [Number:3] [Pages:46] [Pages No:109-111][No of Hits : 860]


ABSTRACT

We report a case of a 50-year-old male diagnosed with fracture tibia shaft posted for open reduction internal fixation (tibial interlocking). His comorbidities included diabetes mellitus (DM), hypertension, ischemic heart disease (IHD), and chronic obstructive pulmonary disease (COPD). The surgery was successfully completed under regional anesthesia with single injection combined sciatic femoral nerve block using peripheral nerve stimulator (PNS). Regional techniques like peripheral nerve block are preferred modalities to avoid undue complication of general anesthesia and to provide adequate postoperative analgesia. It provides good intraoperative conditions with adequate postoperative analgesia with least hemodynamic alterations in high-risk cases, especially IHD.

Keywords: Combined sciatic femoral nerve block, Postoperative analgesia, Tibial interlocking.

How to cite this article: Shivhare P, Chansoria M, Vyas A, Dalal A. Single Injection Combined Femoral Sciatic Nerve Block in Lower Limb Orthopedic Surgery in a High-risk Patient. J Recent Adv Pain 2016;2(3):109-111.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Raghvendra Upadhyay, Mayank Chansoria, Ravindra Harne, Ruchi Singh

Single Level Thoracic Paravertebral Block for Analgesia in Modified Radical Mastectomy in a Comorbid Female

[Year:2016] [Month:January-April] [Volumn:2 ] [Number:1] [Pages:36] [Pages No:25-27][No of Hits : 828]


ABSTRACT

We report a case of 50 years old female diagnosed with carcinoma of breast posted for modified radical mastectomy (MRM). Her comorbidities included diabetes mellitus (DM), hypertension, ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD). She was also anxious about postoperative analgesia. The surgery was successfully completed under general anesthesia (GA) with single level thoracic paravertebral block (PVB) using peripheral nerve stimulator (PNS). Regional techniques like PVB are preferred modalities for perioperative analgesia. It provides good intraoperative conditions with adequate postoperative analgesia with least hemodynamic alterations in high risk cases specially IHD.

Keywords: Carcinoma breast, Paravertebral block, Postoperative analgesia.

How to cite this article: Upadhyay R, Chansoria M, Harne R, Singh R. Single Level Thoracic Paravertebral Block for Analgesia in Modified Radical Mastectomy in a Comorbid Female. J Recent Adv Pain 2016;2(1):25-27.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Shane Meraj, Gautam Das

Thoracic Facet Arthropathy Presenting with Pain Abdomen: An Unusual Presentation

[Year:2016] [Month:January-April] [Volumn:2 ] [Number:1] [Pages:36] [Pages No:31-32][No of Hits : 814]


ABSTRACT

This case report is about a patient with thoracic facet arthropathy presenting with abdominal pain, who underwent multiple investigations and treatment for abdominal visceral conditions with no relief of his pain. A 29 years male presented to our pain clinic with episodic, severe left chest wall, and upper abdominal pain. In the last 4 years, he had been treated for various abdominal visceral conditions. He was then diagnosed as a case of intercostal neuralgia and 12th rib (the twelfth rib syndrome). He was treated with anticonvulsants and antidepressants, as well as intercostal nerve block, tender point injection and intercostal nerve radiofrequency (RF), but with partial relief. Careful history and clinical examination revealed left lower thoracic facet joint involvement. Diagnostic block of medial branch of left 10, 11 and 12th thoracic dorsal rami was done with 90% pain relief. This case emphasises that in any case of abdominal pain, spine should be examined because referred pain from spine can be an important etiology of pain abdomen. Careful history, examination and appropriate investigations should be done to rule out abdominal pathologies, and to arrive at a diagnosis. A thorough history, meticulous examination, and diagnostic blocks if required are very important to localize the pain generators.

Keywords: Abdominal pain, Diagnostic block, Intercostal neuralgia, Thoracic facet arthropathy.

How to cite this article: Meraj S, Das G. Thoracic Facet Arthropathy Presenting with Pain Abdomen: An Unusual Presentation. J Recent Adv Pain 2016;2(1):31-32.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Ruchi Singh, Mayank Chansoria, Amit K Choukse, Neha Vyas

A Novel Technique of Epidural Catheter Fixation

[Year:2016] [Month:January-April] [Volumn:2 ] [Number:1] [Pages:36] [Pages No:28-30][No of Hits : 781]


ABSTRACT

We report a case of 45 years old female posted for cholecystectomy for gall bladder stone under combined epidural and general anesthesia. Epidural catheter was inserted at T9 to T10 and fixed by subcutaneous tunneling followed by suturing and looping. An insignificant dislodgement of 2 mm was observed with a good postoperative analgesia and patient satisfaction score with only mild signs of inflammation after 3 days.

Keywords: Dislodgement, Epidural catheter, Fixation, Technique.

How to cite this article: Singh R, Chansoria M, Choukse AK, Vyas N. A Novel Technique of Epidural Catheter Fixation. J Recent Adv Pain 2016;2(1):28-30.

Source of support: Nil

Conflict of interest: None


 
EDITORIAL
Abu Bakar Siddiq

Superior Cluneal Nerve Disorder: How often do We Consider?

[Year:2016] [Month:January-April] [Volumn:2 ] [Number:1] [Pages:36] [Pages No:4-5][No of Hits : 741]


ABSTRACT

The superior cluneal nerve (SCN) is formed by the cutaneous branches of the dorsal rami of T11-L4 and supplies skin over the buttocks.1 The first detailed description focusing SCN and low back pain (LBP) was made by Strong and Davila in 1957.2


 
ORIGINAL ARTICLE
Kawsar Sardar, M Omar Faruque, Gautam Das, Richard Hubbard, Nicholas CH Liang, Harvey Finkelstein, Pankaj N Surange, Geeta Joshi

A Comparison of Intradiscal Ozone with Transforaminal Triamcinolone and Bupivacaine to Ozone Therapy alone in the Treatment of Discogenic Sciatica

[Year:2016] [Month:September-December] [Volumn:2 ] [Number:3] [Pages:46] [Pages No:77-81][No of Hits : 695]


ABSTRACT

Introduction: Ozone disk nucleolysis is a nonsurgical percutaneous procedure for the treatment of discogenic sciatica, and published success rates of ozone disk nucleolysis vary significantly. This study assesses the outcome difference between two treatment modalities among patients with discogenic sciatica secondary to a herniated disk in Bangladesh: Intradiscal ozone injection and combination therapy with intradiscal ozone and transforaminal triamcinolone and bupivacaine injection.

Materials and methods: Prospectively recruited 50 patients (group I) received intradiscal injections of an oxygen-ozone mixture and 150 patients (group II) received identical oxygen- ozone injections, followed by transforaminal triamcinolone 20 mg in 2 mL of 0.25% bupivacaine, in relevant foramen. Discography was noted for each case. All patients underwent follow-up examinations at 1-week, 1-month, and 6-month time points. Clinical outcome was evaluated by using the verbal rating scale (VRS) and modified Macnab method.

Results: According to the modified Macnab method, group II showed “excellent and good” result of about 97, 90, and 88% in 1-week, 1-month and 6-month time points respectively, whereas group I showed 70, 70, and 68% at the same time point. The difference is significant in each time point. Groups I and II demonstrated similar VRS scores prior to intervention, but patients in group II had significantly better VRS pain scores at all three time points.

Conclusion: A combination of transforaminal triamcinolone and local anesthetic with intradiscal ozone provides clearly superior outcomes when compared with ozone therapy alone in discogenic sciatica.

Keywords: Discogenic sciatica, Ozone, Transforaminal. How to cite the article: Sardar K, Faruque MO, Das G, Hubbard R, Liang NCH, Finkelstein H, Surange PN, Joshi G. A Comparison of Intradiscal Ozone with Transforaminal Triamcinolone and Bupivacaine to Ozone Therapy alone in the Treatment of Discogenic Sciatica. J Recent Adv Pain 2016;2(3):77-81.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Surabhi Shekhar, Mayank Chansoria, Meena Singh, Shridhar Khandelwal

Intraperitoneal Instillation of Ropivacaine for Postoperative Pain Relief in Laparoscopic Cholecystectomy in a Comorbid Patient

[Year:2016] [Month:September-December] [Volumn:2 ] [Number:3] [Pages:46] [Pages No:112-114][No of Hits : 680]


ABSTRACT

We report a case of a 55-year-old female diagnosed with multiple gallbladder stones posted for laparoscopic cholecystectomy. Her comorbidities included obesity, diabetes, previous spinal surgery, chronic renal dysfunction with abnormal renal profile. She was also anxious about postoperative pain. The surgery was successfully completed under general anesthesia with intraperitoneal instillation of ropivacaine which was done just before creation of pneumoperitoneum, which also provided excellent postoperative analgesia, good intraoperative conditions with least hemodynamic alterations in a high-risk case where other modalities for postoperative pain relief had their own limitations.

Keywords: Intraperitoneal instillation ropivacaine, Laparoscopic cholecystectomy, Postoperative analgesia.

How to cite this article: Shekhar S, Chansoria M, Singh M, Khandelwal S. Intraperitoneal Instillation of Ropivacaine for Postoperative Pain Relief in Laparoscopic Cholecystectomy in a Comorbid Patient. J Recent Adv Pain 2016;2(3):112-114.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Aman Navani, Gang Li

Chronic Pain Challenge: A Statistical Machine-learning Method for Chronic Pain Assessment

[Year:2016] [Month:September-December] [Volumn:2 ] [Number:3] [Pages:46] [Pages No:82-86][No of Hits : 673]


ABSTRACT

Aim: The objective of Chronic Pain Challenge project is designing and construction of a machine-learning system to calculate the dynamic changes to the chronic pain risk score of an individual based on various weighted health behaviors.

Materials and methods: The visual analog scale (VAS) and Oswestry Disability Index (ODI) ratings of 218 subjects were studied for dynamic changes based on three weighted health behaviors, physical exercise, nutrition, and depression in order to predict their individual and cumulative impact on severity of chronic pain. The predictive function was used to produce confidence and prediction intervals for the calculation of new VAS and ODI scores using supervised and unsupervised machine-learning algorithms and R programing language for statistical computation.

Results: This 9 months research study resulted in the development of innovative design and construction of a machinelearning program that accurately predicted the changes to standardized tests, such as VAS and ODI based on weighted values for depression score (DS), nutrition score (NS) and physical activity score (PAS). The testing of both extreme and moderate ranges of health behavior values in a variety of subjects and comparison against simple weightage confirmed the accuracy and validity of the program.

Conclusion: Chronic Pain Challenge program is a valid and accurate method in predicting chronic pain risk of an individual based on the engagement in various health behaviors. The Chronic Pain Challenge program can predict and prevent progression of chronic pain and disability by global education and empowerment, thereby disrupting the current health care model with the emerging and accelerating technology.

Clinical significance: The Chronic Pain Challenge program is an innovative statistical machine-learning program for chronic pain predictability based on individual’s health behavior patterns.

Keywords: Algorithm, Chronic pain, Health behaviors, Health risk, Health statistics, Machine learning, Pain risk.

How to cite this article: Navani A, Li G. Chronic Pain Challenge: A Statistical Machine-learning Method for Chronic Pain Assessment. J Recent Adv Pain 2016;2(3):82-86.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Monika Dabgotra, Gautam Das, Sunny Malik, Rupak Bhattarai

Mirror Visual Feedback Treatment for Meralgia Paresthetica

[Year:2016] [Month:May-August] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:59-61][No of Hits : 620]


ABSTRACT

Introduction: Meralgia paresthetica is common but often remains unrecognized. The condition is managed with conservative therapy in most cases. Rarely, surgery is required. If it remains unresolved, it can lead to chronic pain. Research on rehabilitation therapy of meralgia paresthetica is sparse. Mirror therapy is a simple, noninvasive neurorehabilitation technique without side effects. We investigated the role of mirror therapy with brushing of thigh in our patient who has already been treated with various conservative therapies without any improvement. Our patient showed effective pain relief after mirror therapy.

Keywords: Chronic pain, Meralgia paresthetica, Mirror therapy.

How to cite this article: Dabgotra M, Das G, Malik S, Bhattarai R. Mirror Visual Feedback Treatment for Meralgia Paresthetica. J Recent Adv Pain 2016;2(2):59-61.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Seema Yadav, Gautam Das, Sunny Malik

Magnetic Resonance Imaging alone is not enough to rule out the Radiculopathy, Diagnostic Interventions has a Role!

[Year:2016] [Month:January-April] [Volumn:2 ] [Number:1] [Pages:36] [Pages No:33-35][No of Hits : 610]


ABSTRACT

Entrapment of sciatic nerve due to spasm of piriformis muscle known as piriformis syndrome. It produces radiating pain in buttock, posterior thigh and lower leg that actually originate from the compression of nerve plexus under piriformis muscle, not from the nerve root. Diagnosis of piriformis syndrome is primarily based on patients history, physical examination and diagnostic piriformis muscle block. Diagnostic modalities, such as magnetic resonance imaging (MRI), electromyography (EMG)/nerve conduction velocity (NCV), ultrasonography and computed tomography (CT) scan mostly useful to rule out the other condition of low back pain includes prolapsed disk, facet arthropathy, spinal stenosis and muscle strain. We reported a case of piriformis syndrome with the signs and symptoms mimicking L5-S1 radiculopathy and diagnosed by diagnostic local anesthetic and corticosteroid piriformis muscle injection.

Keywords: Low back pain, Piriformis syndrome, Radiculopathy.

How to cite this article: Yadav S, Das G, Malik S. Magnetic Resonance Imaging alone is not enough to rule out the Radiculopathy, Diagnostic Interventions has a Role! J Recent Adv Pain 2016;2(1):33-35.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Somnath Mandal, Dipasri Bhattacharya, Sandip Roy, Anjana Bose, Mohan C Mandal, Gautam Choudhury

Comparative Study of Analgesic Effects of Intraarticular Administration of Equipotent Dose of Morphine and Fentanyl with Bupivacaine and Bupivacaine alone in Arthroscopic ACL Reconstruction

[Year:2016] [Month:September-December] [Volumn:2 ] [Number:3] [Pages:46] [Pages No:72-76][No of Hits : 602]


ABSTRACT

Intraarticular (IA) local anesthetics and opioids are often used for the management and prevention of pain after arthroscopic anterior cruciate ligament (ACL) reconstruction. In this study, analgesic efficacy of IA administration of equipotent dose of morphine and fentanyl with bupivacaine and bupivacaine alone in arthroscopic ACL reconstruction under spinal anesthesia has been compared. Forty-five patients, aged between 15 and 55 years, of American Society of Anesthesiologists (ASA) grade I and II were assigned into three equal groups (n = 15) in a randomized double-blind protocol. Group B received 20 mL of 0.25% bupivacaine and 1 mL normal saline (NS); group BF received 20 mL of 0.25% bupivacaine and 50 µg (1 mL) fentanyl; and group BM received 20 mL of 0.25% bupivacaine and 5 mg (0.5 mL) morphine and 0.5 mL NS through IA route at the end of the procedure. Postoperative analgesia was assessed by visual analogue scale (VAS) score. The VAS score in BM group was less during all the time in the postoperative period compared with the other two groups. This group also experienced longer duration of postoperative analgesia and lesser rescue analgesic. Intraarticular administration of morphine and bupivacaine is safe and provides prolonged analgesia with minimal side effects compared with bupivacaine and fentanyl and bupivacaine alone.

Keywords: Anterior cruciate ligament reconstruction, Bupivacaine, Fentanyl, Intra-articular administration, Morphine, Visual analogue scale score. How to cite the article: Mandal S, Bhattacharya D, Roy S, Bose A, Mandal MC, Choudhury G. Comparative Study of Analgesic Effects of Intraarticular Administration of Equipotent Dose of Morphine and Fentanyl with Bupivacaine and Bupivacaine alone in Arthroscopic ACL Reconstruction. J Recent Adv Pain 2016;2(3):72-76.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Nelson Hendler

Why Chronic Pain Patients are Misdiagnosed 40 to 80% of the Time?

[Year:2016] [Month:September-December] [Volumn:2 ] [Number:3] [Pages:46] [Pages No:94-98][No of Hits : 589]


ABSTRACT

Researchers from Johns Hopkins Hospital have reported that 40%-80% of chronic pain patients are misdiagnosed. The leading causes for these errors are a failure to take a thorough and comprehensive history from the patient, and ordering the wrong tests. Typical testing errors are the use of anatomical tests to detect the physiological phenomenon of chronic pain, and a failure to understand the specificity and sensitivity of medical testing commonly in use.

Keywords: 3D-CT, Chronic pain, CRPS, Current perception threshold, Evidence based medicine, Facet blocks, Facet syndrome, Fibromyalgia, Fraud, Histrionic personality, Malingering, Misdiagnosis, Modic sign, MRI, Outcome studies, Provocative discogram, RSD, Roos, Root block, Thoracic outlet syndrome.

How to cite this article: Hendler N. Why Chronic Pain Patients are Misdiagnosed 40 to 80% of the Time? J Recent Adv Pain 2016;2(3):94-98.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Kanchan Sharma, Gautam Das, Samarjit Dey, Emmanuell Q Villano, Sripurna Mandal

Neuropathic Pain and Depression: A Prospective Study to find out Any Association

[Year:2016] [Month:January-April] [Volumn:2 ] [Number:1] [Pages:36] [Pages No:6-10][No of Hits : 580]


ABSTRACT

Introduction: The effect of duration, severity, response to treatment, family and social interactions with chronic pain and depression have been studied extensively. But, none of the studies have ever reported any association of the character of chronic pain particularly neuropathic pain with depression. The aim of this study is to find out the association of neuropathic pain (using painDETECT tool) and depression [using the patient health questionnaire (PHQ-9) scale].

Materials and methods: A prospective analysis of 250 patients, aged 18 to 65 years of either sex suffering from chronic pain for more than 3 months’ duration with an average pain score of 4/10 or more on numerical rating scale (NRS) and moderate to severe depression diagnosed using PHQ-9 scale, were included in the study. Neuropathic character of pain was diagnosed using painDETECT tool. We analyzed the possible association of neuropathic pain with depression.

Results: In 3.2% of patients were found to be suffering from neuropathic pain, 19.6% patients were non-neuropathic or nociceptive pain and 77.2% patients were suffering from mixed type of pain where neuropathic pain may be present. The average depression score on PHQ-9 scale was 14.58 ± 3.72. In 58.4% of patients the depression was moderate, 30.4% of patients the depression was moderately severe and 11.2 % of patients were suffering from severe depression. On analysis of data, we have found that there is no statistically significant association between neuropathic pain and depression (p = 0.8).

Conclusion: We did not find any statistically significant correlation between neuropathic pain and depression.

Keywords: Chronic pain, Depression, Neuropathic pain, PainDETECT tool, PHQ-9 scale.

How to cite this article: Sharma K, Das G, Dey S, Villano EQ, Mandal S. Neuropathic Pain and Depression: A Prospective Study to find out Any Association. J Recent Adv Pain 2016;2(1):6-10.

Source of support: Nil

Conflict of interest: None


 
PRACTITIONER’S SECTION
R Gurumoorthi, N Vanathi

Sacroiliac Joint Injection

[Year:2016] [Month:September-December] [Volumn:2 ] [Number:3] [Pages:46] [Pages No:87-89][No of Hits : 572]


ABSTRACT

Sacroiliac joint (SIJ) is third most common cause for low back pain. SIJ block is one of the common procedures done in pain clinic. Though this procedure is relatively complication free, it is technically difficult due to joint anatomy. With better knowledge of joint anatomy and needling skill, this block can be made easy and successful.

Keywords: Sacroiliac joint, Sacroiliac joint block, Technical difficulty.

How to cite this article: Gurumoorthi R, Vanathi N. Sacroiliac Joint Injection. J Recent Adv Pain 2016;2(3):87-89.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Mayank Chansoria, Amruta Sahasrabuddhe, Sonal Yadav, Neha Vyas

Postherpetic Neuralgia: From Phenytoin to Ultrasonography-guided Blocks

[Year:2016] [Month:January-April] [Volumn:2 ] [Number:1] [Pages:36] [Pages No:18-21][No of Hits : 565]


ABSTRACT

Postherpetic neuralgia (PHN) is a painful condition affecting 2% of the patients suffering from herpes zoster (HZ). Most common risk factor for developing PHN is age. Pain has a dermatomal distribution; is confined to same dermatome as the rash. Various treatment modalities have been tried to reduce this pain and improve the quality of life of the patient. Varicella zoster vaccine has shown promising results in preventing the development of HZ as well as PHN. Early treatment with antiviral drugs within 72 hours is also helpful to decrease the incidence of PHN. There has been a gradual transition in the treatment modalities, from oral anticonvulsants, antidepressants, opiods, to combination therapies of these drugs, which reduces side-effects and improves efficacy. Now the focus had shifted to eliminate the oral route altogether. Nowadays topical applications are being used. Various topical modalities available are 5% lignocaine patch, 8% capsacian patch. Latest development is a 6% gabapentin patch. There is a combined patch which has a mix of gabapentin, ketoprofen, ketamine and lignocaine which has also been used in a case report. The most recent advance in the treatment modality is transcutaneous electrical nerve stimulation, which has shown to prevent development of PHN as well as has shown promising results to decrease the pain. When the pain is not responding to any of the treatment modalities mentioned above, ultrasonography (USG)-guided musculocutaneous peripheral nerve block has been used and it has shown positive results. Out of all the treatment modalities available in our armour, we can choose either one or a multimodal approach, depending on the patient’s condition, and provide pain relief to our patients.

Keywords: Anticonvulsants, Antidepressants, Postherpetic neuralgia, Transcutaneous electrical nerve stimulation, USG guided musculocutaneous peripheral nerve block.

How to cite this article: Chansoria M, Sahasrabuddhe A, Yadav S, Vyas N. Postherpetic Neuralgia: From Phenytoin to Ultrasonography- guided Blocks. J Recent Adv Pain 2016;2(1):18-21.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Komal Kashyap, Silvy Varghese, Sushma Bhatnagar

Scrambler Therapy for Treatment of Chronic Nonmalignant Pain

[Year:2016] [Month:September-December] [Volumn:2 ] [Number:3] [Pages:46] [Pages No:102-105][No of Hits : 550]


ABSTRACT

Aim: The aim of this study is to investigate scrambler therapy as a modality of treatment for chronic pain.

Materials and methods: Four patients with chronic drugresistant severe pain were treated with scrambler therapy, a new bioengineering-based method for treating pain, especially neuropathic pain. The effectiveness of the treatment was evaluated using numeric rating score (NRS); reduction in amount of pain medications and side effects if any were also noted. Each patient was given 10 cycles (or the number of cycles required for complete pain relief) of 30 minutes duration each, and the above parameters were noted.
Three of the four patients had chronic neuropathic pain, and the fourth patient had somatic (bony) pain. All of them showed more than 80% reduction in their pain scores and reduction in the consumption of pain medications.

Keywords: Disk prolapse, Neuropathic pain, Numeric rating scale, Scrambler therapy.

How to cite this article: Kashyap K, Varghese S, Bhatnagar S. Scrambler Therapy for Treatment of Chronic Nonmalignant Pain. J Recent Adv Pain 2016;2(3):102-105.

Source of support: Nil

Conflict of interest: None


 
EDITORIAL
Samarjit Dey

Acute Pain Services: Recognizing the Reality!!

[Year:2016] [Month:May-August] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:37-38][No of Hits : 548]


ABSTRACT

Acute pain is probably one of the most feared symptoms in patients undergoing surgery. It is also one of the most neglected issues in postoperative period. Effective acute pain management is an important component of quality patient care. Impact of unrelieved pain is known to all physicians, which may include most of the major systems in the body with an added disadvantage of delayed recovery.1


 
ORIGINAL ARTICLE
Dikshanand Dongre, Mamta Mahobia, Neeraj Narang

Comparison between Hemodynamic Changes and Time to First Postoperative Analgesic Requirement in Patients undergoing Unilateral and Bilateral Spinal Anesthesia for Lower Limb Surgeries

[Year:2016] [Month:May-August] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:39-43][No of Hits : 543]


ABSTRACT

Introduction: Unilateral spinal anesthesia is more favorable than bilateral spinal anesthesia. This study was done to compare hemodynamic changes and time to first postoperative analgesic requirement in patients undergoing unilateral and bilateral spinal anesthesia for lower limb surgeries.

Materials and methods: A prospective, randomized study was done in 60 patients of American Society of Anesthesiologists grade 1 undergoing lower limb surgery. Patients were randomized into two groups. Group A (n = 30) received bilateral spinal anesthesia, and group B (n = 30) received unilateral spinal anesthesia. Onset, duration, and time to reach maximum height of sensory block; duration of analgesia; and hemodynamic variables were studied in the two groups.

Results: Duration, time to reach maximum height of sensory block, and duration of analgesia were longer in group B. There were less hemodynamic changes in group B.

Conclusion: Unilateral spinal anesthesia offers more favorable hemodynamic and postoperative analgesic outcome when compared with bilateral spinal anesthesia.

Keywords: Levobupivacaine, Postoperative analgesic requirements, Spinal anaesthesia.

How to cite this article: Dongre D, Mahobia M, Narang N. Comparison between Hemodynamic Changes and Time to First Postoperative Analgesic Requirement in Patients undergoing Unilateral and Bilateral Spinal Anesthesia for Lower Limb Surgeries. J Recent Adv Pain 2016;2(2):39-43.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Pravin Thomas, Gautam Das

The Diagnostic Dilemma of a Genitofemoral-ilioinguinal Overlap Syndrome

[Year:2015] [Month:May-August] [Volumn:1 ] [Number:1] [Pages:63] [Pages No:28-30][No of Hits : 3999]


ABSTRACT

Background: It is sometimes difficult to clinically delineate genitofemoral and ilioinguinal neuralgias because of the overlap in the clinical symptomatology.

Case description: A young male with a past history of transurethral removal of ureteral calculi presented with severe, debilitating neuropathic pain in the groin. He had hyperpathia and allodynia in the distribution of genitofemoral nerve, and hence a clinical diagnosis of genitofemoral neuralgia was made. An ultrasound guided diagnostic block of the genitofemoral nerve with local anesthetic produced only a mild reduction in pain (VAS 2 reduction). A repeat diagnostic block of the ilioinguinal nerve produced complete resolution of pain.
Literature search showed a limited number of case reports of ultrasound guided blocks for genitofemoral neuralgia; and overlap syndromes have been addressed with differential nerve blocks.

Clinical relevance: Our hypothesis is that an aberrant reinnervation from the ilioinguinal to genitofemoral nerve may present with features favoring a genitofemoral neuralgia. In situations where radiofrequency treatment is being considered, such cases may pose a failed intervention if both nerves are not separately targeted.

Keywords: Genitofemoral, Ilioinguinal, Neuralgia.

How to cite this article: Thomas P, Das G. The Diagnostic Dilemma of a Genitofemoral-ilioinguinal Overlap Syndrome. J Recent Adv Pain 2015;1(1):28-30.

Source of support: Nil

Conflict of interest: None


 
Review Article
Rammurthy Kulkarni

Clinical Evaluation of Upper and Mid Back Pain

[Year:2015] [Month:September-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:87-89][No of Hits : 2474]


ABSTRACT

Evaluation of any painful condition requires a thorough clinical examination, so as the upper back pain. Although upper back pain is not as common as low backache, its prevalence is high enough to categorize it under occupational health problems. Evaluation of upper back pain is very important as it can be due to serious conditions involving the visceral organs like myocardium, pancreas, esophagus or it can also be the first symptom of serious disorders in the spine like infection or tumor. In this article, we have tried to summarize the systematic examination of the upper back.

Keywords: Clinical examination, Evaluation, Upper back pain.

How to cite this article: Kulkarni R. Clinical Evaluation of Upper and Mid Back Pain. J Recent Adv Pain 2015;1(2):87-89.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Mayank Chansoria, Sevras Hingwe, Ashish Sethi, Ruchi Singh

Evaluation of Transversus Abdominis Plane Block for Analgesia after Cesarean Section

[Year:2015] [Month:May-August] [Volumn:1 ] [Number:1] [Pages:63] [Pages No:13-17][No of Hits : 1654]


ABSTRACT

Background: This study is intended to evaluate the transversus abdominis plane (TAP) block for analgesia over the first 24 postoperative hours after lower segment cesarean section.

Materials and methods: Fifty female parturients of American society of Anesthesiologists (ASA) physical status II undergoing lower segment cesarean section were randomized to undergo a bilateral TAP block with ropivacaine (group 1 = 25) or to undergo a bilateral TAP block with 0.9% saline (group 2 = 25). In addition, all patients received standard analgesic injection tramadol 100 mg and im injection diclofenac 75 mg as required in the postoperative period. All patients received standard spinal anesthesia, and TAP block was performed at end of the surgery. Each patient was assessed after operation at each half an hours up to 24 hours after surgery in postoperative period.

Results: The mean visual analog scale (VAS) score of group 1 was statistically less than mean VAS score of group 2 (p < 0.001). The mean of total number analgesic requirement for first 24 hours postoperatively was significantly less in group 1 (1.68 ± 0.9) than group 2 (2.8 ± 0.33) respectively.

Conclusion: Transversus abdominis plane block holds considerable promise as part of a multimodal analgesic regimen for post cesarean delivery analgesia. Transversus abdominis plane block is easy to perform and provided reliable and effective analgesia.

Keywords: Analgesia, Lower segment cesarean section, Transversus abdominis plane block.

How to cite this article: Chansoria M, Hingwe S, Sethi A, Singh R. Evaluation of Transversus Abdominis Plane Block for Analgesia after Cesarean Section. J Recent Adv Pain 2015;1(1):13-17.

Source of support: Nil

Conflict of interest: None


 
Original Article
Usha Bafna, Gaurav Sharma, Sindhu Sapru, Mamta Khandelwal, Varsha Kothari, Rajni Mathur

Comparison of Clonidine and Dexmedetomidine as an Adjuvant to 0.5% Ropivacaine in Supraclavicular Brachial Plexus Block: A Prospective, Randomized, Double-blind, Controlled Study

[Year:2015] [Month:September-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:73-77][No of Hits : 1569]


ABSTRACT

Background: Brachial plexus blockade is the cornerstone of regional anesthesia practice. This study was done to compare clonidine and dexmedetomidine as an adjuvant to 0.5% ropivacaine in supraclavicular brachial plexus block (SCB).

Materials and methods: A prospective, randomized, double-blind study was done in 120 patients of American Society of Anaesthesiologist (ASA) grade I and II undergoing elective upper limb surgery under SCB. Patients were randomized into three groups. Group 1 (n = 40) received 30 ml of 0.5% ropivacaine, group 2 (n = 40) received 30 ml of 0.5% ropivacaine with 2 μg/kg clonidine, and group 3 (n = 40) received 30 ml of 0.5% ropivacaine with 1 μg/kg dexmedetomidine. Onset and recovery time of sensory and motor block, duration of analgesia and quality of block, hemodynamic variables, and level of sedation were studied in the three groups.

Results: Sensory and motor block onset times were shorter in group 3 than in group 1 and 2 (p < 0.0001). Sensory and motor block durations and duration of analgesia were longer in group 3 than in groups 1 and 2 (p < 0.0001). Blood pressure and heart rate were lower in group 3 as compared to groups 1 and 2 (p < 0.0001). The number of patients achieving grade IV quality of block was higher in group 3 as compared to the other groups.

Conclusion: Dexmedetomidine when added in SCB shortened the onset of sensory and motor block and enhances the duration of sensory and motor block and duration of analgesia without significant side effects.

Keywords: Clonidine, Dexmedetomidine, Ropivacaine, Supraclavicular brachial plexus block.

How to cite this article: Bafna U, Sharma G, Sapru S, Khandelwal M, Kothari V, Mathur R. Comparison of Clonidine and Dexmedetomidine as an Adjuvant to 0.5% Ropivacaine in Supraclavicular Brachial Plexus Block: A Prospective, Randomized, Double-blind and Controlled Study. J Recent Adv Pain 2015;1(2):73-77.

Source of support: Nil

Conflict of interest: None


 
International Conference on Recent Advances in Pain 2015
Ajay Basarigidad, Rammurthy, Syed Fazal Mahmood, S Padmanabha

A Survey on Knowledge and Attitude toward Chronic Pain among Interns in Yenepoya University, Mangalore, South India

[Year:2015] [Month:May-August] [Volumn:1 ] [Number:1] [Pages:63] [Pages No:36-63][No of Hits : 1548]


ABSTRACT

BACKGROUND AND AIMS

Interns, being budding doctors and future prospects, have a key role in effective pain management; therefore, interns’ knowledge is of critical importance in treating pain. The interns’ accurate assessment, prompt intervention, and adequate evaluation of pain relief measures are necessary for better clinical outcomes.
Hence, we take up this study to evaluate the knowledge and attitude with a questionnaire, regarding chronic pain management among interns in Yenepoya University, Mangalore city, South India.


 
CASE REPORT
Mohammad Moin Uddin, Md Abu Bakar Siddiq, Aminuddin A Khan

Lipoma Arborescens in Bicipitoradial Bursae: A Rare Anterior Painful Elbow Swelling with Dual Morphology

[Year:2015] [Month:May-August] [Volumn:1 ] [Number:1] [Pages:63] [Pages No:33-35][No of Hits : 1380]


ABSTRACT

Lipoma arborescens (LA) is a benign rare synovial neoplasm characterized by hyperplastic proliferation of fatty tissue that replaces the subsynovial connective tissue layer. Lipoma arborescens usually grows inside the joints, but it is also rarely found inside a bursae. This is a case of LA inside bicipitoradial bursae of a 50 years lady. Although six cases of LA in bicipitoradial bursae had been previously described in literature, this case is unique as features of two different types of morphology documented in the same lipoma. Here, in this write-up we describe common clinical features and sonographic findings LA in a middle-aged Bangladeshi woman.

Keywords: Bicipitoradial bursae, Dual morphology, Elbow swelling, Lipoma arborescens, Ultrasound.

How to cite this article: Uddin MM, Siddiq MAB, Khan AA. Lipoma Arborescens in Bicipitoradial Bursae: A Rare Anterior Painful Elbow Swelling with Dual Morphology. J Recent Adv Pain 2015;1(1):33-35.

Source of support: Nil

Conflict of interest: None


 
Case Report
Ashok Jadon

Bipolar Radiofrequency Ablation of Genicular Nerves in Patients with Pacemaker

[Year:2015] [Month:September-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:97-99][No of Hits : 1324]


ABSTRACT

Radiofrequency ablation (RFA) of genicular nerves (GN) provides good long-term pain relief in patients with knee joint pain. Unipolar RFA is commonly used technique, however, it is contraindicated in patients with implanted pacemaker due to risk of pacemaker failure and arrhythmia. We present a case report of two cases of genicular nerve RFA where bipolar RFA was used successfully in patients with permanent pacemaker to manage chronic knee pain. Both patients showed effective pain relief. Bipolar RFA was done uneventfully without any complication.

Keywords: Bipolar RFA, Genicular nerves, Knee pain, Pacemaker, Radiofrequency ablation.

How to cite this article: Jadon A. Bipolar Radiofrequency Ablation of Genicular Nerves in Patients with Pacemaker. J Recent Adv Pain 2015;1(2):97-99.

Source of support: Nil

Conflict of interest: None


 
Original Article
Anoop Singh Negi, Mayank Gupta, Ashutosh Singh

Comparison of Effect of Intrathecal Buprenorphine vs Clonidine as an Adjuvant to Hyperbaric Bupivacaine on Subarachnoid Block Characteristics

[Year:2015] [Month:September-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:67-72][No of Hits : 1257]


ABSTRACT

Background and aims: There are very few reported clinical trials with direct comparison of buprenorphine and clonidine on subarachnoid block characteristics. The aim of the present study was to compare the effect of buprenorphine 75 μg and clonidine 37.5 μg as an adjuvant to 15 mg of 0.5% bupivacaine in lower limb surgeries with respect to the subarachnoid block characteristics, postoperative analgesia and side-effects.

Methods: One hundred patients of 15 to 60 years, either sex and American Society of Anesthesiologist (ASA) I/II undergoing elective lower limb surgeries under planned spinal anesthesia were included and randomly allocated into two equal groups (n = 50 each) to receive 3 ml of intrathecal 0.5% bupivacaine (heavy) with either clonidine 37.5 μg (group C) or buprenorphine 75 μg (group B) to a total volume of 3.25 ml. The patients were evaluated with respect to various sensory and motor block characteristics, duration of postoperative analgesia and adverse effects.

Result: Both the groups were comparable with respect to demographic profile. There was significant prolongation in the duration of sensory block (119.26 ± 24.56 vs 79.40 ± 15.67; p = 0.0), motor block (277.90 ± 37.56 vs 198.80 ± 42.21; p = 0.0) and postoperative analgesia (355.80 ± 63.85 vs 283.20 ± 51.84; p = 0.0) in group C compared with group B. There was clinically significant earlier onset of maximum sensory block (9.20 ± 5.69 vs 11.90 ± 4.78; p = 0.018) and motor block (5.10 ± 3.39 vs 11.90 ± 4.78; p = 0.018) in group C compared with group B however the results were statistically significant only for time to attain maximum sensory block. The incidence of shivering was significantly lower in group C compared with group B.

Conclusion: Intrathecal 37.5 μg clonidine seems to be an attractive alternative to 75 μg buprenorphine as an adjuvant to spinal bupivacaine in terms of duration of sensory and motor blockade, postoperative analgesia and having less side-effects.

Keywords: Analgesia, Anesthesia, Buprenorphine, Clonidine, Subarachnoid.

How to cite this article: Negi AS, Gupta M, Singh A. Comparison of Effect of Intrathecal Buprenorphine vs Clonidine as an Adjuvant to Hyperbaric Bupivacaine on Subarachnoid Block Characteristics. J Recent Adv Pain 2015;1(2):67-72.

Source of support: Nil

Conflict of interest: None


 
Editorial
R Gurumoorthi

Platelet Rich Plasma, Platelet Lysate, Freeze-dried Platelets and Next

[Year:2015] [Month:September-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:65-66][No of Hits : 1196]


ABSTRACT

Platelet rich plasma (PRP), an autologous plasma fraction of peripheral blood, is the simplest regenerative medicine intervention that is rapidly extending to multiple medical fields mainly due to the easy use and biosafety that facilitates translation in humans.1 In fact, regulatory requirements for any cell therapy involve multiple preclinical experiments to demonstrate their safety and nonteratogen effects in addition to GLP compliance in the preparation, and the use of adequate expensive installations.2 In contrast, PRP therapies involve minimal manipulation and, in general, regulatory requirements are easy to comply thereby facilitating the widespread clinical use and commercial success of PRP kits and devices.


 
CASE REPORT
Emmanuell Q Villano, Gautam Das, Kanchan Sharma, Kishan Rijhwani

A Case of Piriformis Syndrome Mimicking Radiculopathy

[Year:2015] [Month:May-August] [Volumn:1 ] [Number:1] [Pages:63] [Pages No:24-25][No of Hits : 1070]


ABSTRACT

Piriformis syndrome constitutes a constellation of sign and symptoms and has always remained as a diagnostic dilemma for pain physician. Piriformis syndrome not only causes pain due to its myofascial trigger point but also due to nerve compression and injury on sciatic nerve and its branches. The neural irritation to the sciatic nerve will cause radiculopathy like pain which is misleading the diagnosis to a lumbar nerve root pain. Piriformis syndrome remains a challenge to physician and burden to patients having this syndrome and costly to the society. Diagnostic piriformis block remains a standard for diagnosis and modalities like magnetic resonance imaging (MRI) and nerve conduction velocity (NCV) testing would be helpful in ruling out other diseases. This is a case report of a piriformis syndrome patient presented with radicular symptoms of the leg.

Keywords: Magnetic resonance imaging, Nerve conduction velocity, Piriformis syndrome, Radiculopathy.

How to cite this article: Villano EQ, Das G, Sharma K, Rijhwani K. A Case of Piriformis Syndrome Mimicking Radiculopathy. J Recent Adv Pain 2015;1(1):24-25.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Sripurna Mandal, Gautam Das, B Sarvesh, Pravin Thomas, Istiana Sari

Atypical Presentation of S1 Radiculopathy Like Plantar Fasciitis

[Year:2015] [Month:May-August] [Volumn:1 ] [Number:1] [Pages:63] [Pages No:31-32][No of Hits : 1068]


ABSTRACT

Objective: This case report presents a patient that had an atypical presentation of radiculopathy which was misdiagnosed as plantar fasciitis.

Clinical features: A 67-year-old male patient had presented with primary complain of continuous, aching, pain involving the sole of both feet, aggravated with walking. He had been treated as a case of plantar fasciitis, including depot steroid injection. He had presented to our clinic failing these measures. Clinical evaluation and neurophysiologic study diagnosed him to be a case of bilateral S1 radiculopathy.

Conclusion: This case emphasizes the importance of differentiation between neuropathic and nociceptive pain by clinical examination and nerve conduction study.

Keywords: Plantar fasciitis, Radiculopathy, Low back pain.

How to cite this article: Mandal S, Das G, Sarvesh B, Thomas P, Sari I. Atypical Presentation of S1 Radiculopathy Like Plantar Fasciitis. J Recent Adv Pain 2015;1(1):31-32.

Source of support: Nil

Conflict of interest: None


 
Editorial 1
Samarjit Dey

Ultrasound-guided Interventions in Chronic Pain: Are We Ready for It Yet?

[Year:2015] [Month:May-August] [Volumn:1 ] [Number:1] [Pages:63] [Pages No:1-2][No of Hits : 964]


ABSTRACT

Intervention is an integral part of chronic pain management, whether it is diagnostic or therapeutic. The precision of correct needle positioning is of utmost importance. Most of the interventions need image guidance for better safety and selectivity. Traditionally anatomical landmarks, computed tomography (CT) or fluoroscopy has been the third eye of an interventional pain physician. However, fluoroscopy is more feasible than CT and safer in account of radiation exposure. Though ultrasound is a well established modality in acute pain management and peripheral nerve blocks, its major role in chronic pain management and interventions, though has passed the embryonic stages but still developing.


 
Clinical Investigation Report
Dipasri Bhattacharya, Sayantan Mukhopadhyay, Arindam Hazra

Fluoroscopy-guided Lumbar Sympathetic Block with Bupivacaine and Depot Methyl Prednisolone for Pain Relief in Buerger’s Disease—Our Experience

[Year:2015] [Month:September-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:90-94][No of Hits : 935]


ABSTRACT

Background: Buerger’s disease (BD) is a common peripheral vascular disease resulting in severe rest pain, leg ulcer, and claudication pain leading to decreased quality of life and disability. Lumbar chemical sympathectomy is now being used to relieve pain in BD.

Purpose of this study was to assess the effectiveness of lumbar sympathetic block (LSB) in relieving rest pain, ulcer healing, decreased swelling and improvement in claudication distance (CD) for a considerable period.

Materials and methods: This was a prospective observational study on thirty-two consecutive patients, who attended our pain clinic. Each patient received LSB bilaterally under fluoroscopy at L3 level with bupivacaine (0.25%) 10 ml and depot methylprednisolone (20 mg) on each side. As per our departmental protocol, the procedure was repeated for three times at an interval of 6 weeks. We compared the pain by visual analog scale (VAS), CD, healing of leg ulcer, pedal swelling following each injection.

Results: Visual analog scale and claudication distance were improved significantly after second and third compared to first intervention (p < 0.05) but no significant differences observed between second and third intervention. Healing of leg ulcers and decreased pedal swelling were observed after each block. Conclusion: Multiple doses of fluoroscopy guided LSB with bupivacaine and depot methyl prednisolone is safe and effective in relieving rest pain, improving CD, promoting ulcer healing in patients of BD when conservative therapies are ineffective but how many doses will be optimal is still a matter of debate.

Keywords: Buerger’s disease, Bupivacaine, Depot methyl prednisolone, Fluoroscopy, Lumbar sympathetic block,

How to cite this article: Bhattacharya D, Mukhopadhyay S, Hazra A. Fluoroscopy-guided Lumbar Sympathetic Block with Bupivacaine and Depot Methyl Prednisolone for Pain Relief in Buerger’s Disease―Our Experience. J Recent Adv Pain 2015;1(2):90-94.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Mayank Chansoria, Arvind Kumar Rathiya, Ashish Sethi, Rita Upadhyay, Neha Vyas

Comparison between Additive Doses of Fentanyl and Clonidine to Lignocaine with Adrenaline in Lower Limb Surgeries under Lumbar Plexus/Sciatic Block

[Year:2015] [Month:May-August] [Volumn:1 ] [Number:1] [Pages:63] [Pages No:18-23][No of Hits : 932]


ABSTRACT

Introduction: There are situations in which block anesthesia would be the technique of choice, if the technique or techniques of blocking the lumbar and sacral plexus could be simplified, as they have been for brachial plexus.

Aims and objectives: Aim of the study is to evaluate the effect of adding fentanyl and clonidine to Lignocaine with adrenaline in lumbar/sciatic block with regard to the following parameters: onset of complete motor and sensory block, duration of motor and sensory block, duration of analgesia, sedative effect of fentanyl and clonidine, hemodynamic changes, complications due to adjuvants and to compare both these adjuvants.

Method study design: Patients were randomly allocated into 2 groups of 30 each.

Groups: Groups L and C (lignocaine with adrenaline + clonidine)- 30 patients received 35 ml lignocaine with adrenaline + 10 ml distilled water diluted clonidine containing 100 µg + 5 ml distilled water, and groups L and F (lignocaine with adrenaline + fentanyl)-30 patients received 35 ml lignocaine with adrenaline + 10 ml distilled water diluted fentanyl containing 100 µg + 5 ml distilled water.

Results: From present study, it can be concluded that Clonidine appears to be better adjuvant for prolongation of anesthesia and analgesia in lower limb surgeries under lumbar plexus/ sciatic block.

Keywords: Clonidine, Fentanyl, Lumbar/sciatic block.

How to cite this article: Chansoria M, Rathiya AK, Sethi A, Upadhyay R, Vyas N. Comparison between Additive Doses of Fentanyl and Clonidine to Lignocaine with Adrenaline in Lower Limb Surgeries under Lumbar Plexus/Sciatic Block. J Recent Adv Pain 2015;1(1):18-23.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Samarjit Dey, Prithwis Bhattacharyya, Priyanka Dev

Intra-articular Injection of Platelet-rich Plasma in the Management of Chronic Low Back Pain due to Facet Arthropathy: A Case Report with 12 Months Follow-up

[Year:2015] [Month:May-August] [Volumn:1 ] [Number:1] [Pages:63] [Pages No:26-27][No of Hits : 872]


ABSTRACT

Platelet-rich plasma prolotherapy (PRPP) helps to heal the injured tissue. Connective tissue repair is the platelet function that PRPP operates on. Platelet concentrations, when increased in a specific area, stimulate rapid healing. The main focus of PRPP is on the alpha granules, as these structures house all of the growth factors essential to PRPP in inactivated forms. Here, we report a case of lumbar facet arthropathy, which was successfully treated with intra-articular PRP injection. Patient was pain free after 12 months follow-up. We want to highlight that intra-articular PRP injection may be a future potential alternative therapy for facet arthropathy.

Keywords: Facet arthropathy, Low back pain, Platelet-rich plasma.

How to cite this article: Dey S, Bhattacharyya P, Dev P. Intraarticular Injection of Platelet-rich Plasma in the Management of Chronic Low Back Pain due to Facet Arthropathy: A Case Report with 12 Months Follow-up. J Recent Adv Pain 2015;1(1): 26-27.

Source of support: Nil

Conflict of interest: None


 
Review Article
Mayank Chansoria, Rita Upadhyay, Neha Vyas

Breakthrough Pain

[Year:2015] [Month:September-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:83-86][No of Hits : 793]


ABSTRACT

Introduction: Breakthrough pain has been defined in recent guidelines as ‘transitory exacerbations of pain that occur on a background of stable pain otherwise adequately controlled by around-the-clock opioid therapy’ or as ‘a transient exacerbation of pain that occurs either spontaneously, or in relation to a specific predictable or unpredictable trigger, despite relatively stable and adequately controlled background pain.’

Types and diagnosis: In general, breakthrough pain can be characterized as incident pain, spontaneous pain, or end-of-dose pain. Assessment is a key step toward adequately managing breakthrough pain in cancer, which is an extraordinarily heterogeneous condition involving different underlying diseases, clinical features and natural histories.

Conclusion: All of the evidence-based guidelines on managing idiopathic breakthrough pain in cancer include rapid-acting opioids as a treatment option, most of which also include fentanyl formulations. A continuity of care is the key to provide the best possible outcome.

Keywords: Breakthrough pain, Fentanyl, Incident pain.

How to cite this article: Chansoria M, Upadhyay R, Vyas N. Breakthrough Pain. J Recent Adv Pain 2015;1(2):83-86.

Source of support: Nil

Conflict of interest: None


 
Original Article
Mayank Chansoria, Gautam Das, Mohammad Ilyas, Ruchi Singh, Dilip Chandar, Neha Vyas

Comparison of Suprascapular Nerve Block (A Novel Technique) and a Combination of Suprascapular Nerve Block Plus Intra-articular Injection in Chronic Shoulder Pain

[Year:2015] [Month:September-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:78-82][No of Hits : 758]


ABSTRACT

Background: Both suprascapular nerve block (SSNB) and intra-articular injection are effective methods for the treatment of chronic shoulder pain. Recently, intra-articular steroid injection (IAI) and SSNB have become popular.

Aims and objectives: To assess and compare the relative effectiveness of a novel technique of SSNB and combined SSNB and IAI steroid on relief of chronic shoulder pain.

Materials and methods: A total of 40 patients were randomized to the two groups. Group A received SSNB by our novel technique, and group B received combined SSNB and IAI. Visual analog scale (VAS) for pain and shoulder pain disability index (SPADI) were assessed before giving the blocks and IAI and at both the follow-up visits, i.e. at 1 and 4 weeks.

Result: Significant improvements were seen in all pain scores and disability in the shoulders in both the groups. Improvements in pain and disability scores were clinically and statistically significant.

Conclusion: Combined IAI and SSNB were found to be better than SSNB alone.

Keywords: Intra-articular injection, Shoulder pain, Suprascapular nerve block.

How to cite this article: Chansoria M, Das G, Ilyas M, Singh R, Chandar D, Vyas N. Comparison of Suprascapular Nerve Block (A Novel Technique) and a Combination of Suprascapular Nerve Block Plus Intra-articular Injection in Chronic Shoulder Pain. J Recent Adv Pain 2015;1(2):78-82.

Source of support: Nil

Conflict of interest: None


 
Case Report
Rammurthy Kulkarni

A Case of Symptomatic Lumbar Perineural Cyst

[Year:2015] [Month:September-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:95-96][No of Hits : 730]


ABSTRACT

Radiculopathy is one of the commonest complaints seen in the pain clinics and herniated intervertebral disk is the cause in most of the cases. Perineural cysts (or Tarlov cysts) are mostly seen in the sacral region and their existence in the lumbar region is extremely rare. Though most of the perineural cysts are asymptomatic, they can produce symptoms ranging from chronic low backache to severe neurologic deficits including cauda equina syndrome. Easily detected by magnetic resonance imaging (MRI), these perineural cysts have to be surgically removed when symptomatic.

Keywords: Perineural cyst, Radiculopathy, Tarlov cyst.

How to cite this article: Kulkarni R. A Case of Symptomatic Lumbar Perineural Cyst. J Recent Adv Pain 2015;1(2):95-96.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Pravin Thomas, Suresh Kumar, Anand Kumar

Pain in Multiple Sclerosis: A South Indian Experience

[Year:2015] [Month:May-August] [Volumn:1 ] [Number:1] [Pages:63] [Pages No:8-12][No of Hits : 708]


ABSTRACT

Pain is a common symptom in multiple sclerosis (MS), with a significant proportion being chronic pain. The profile of MS shows differences based on geographical regions and it has been inadequately studied in South India. The aim of this study was to understand the profile of MS in South India, with specific reference to pain. Patients admitted to a quaternary care center with an MS clinic between 2002 and 2009 were included in the study. Out of 51 patients with MS, 30 patients were followed up and their disability and quality of life (QoL) were assessed. The instruments used were the Kurtzke expanded disability status scale (EDSS) and SF-36 questionnaire. We found that there is a clustering of patients from three districts of Kerala (Eranakulam, Thrissur, Kottayam) probably suggests genetic and environmental factors in the pathogenesis of MS or it may be because of a referral bias. The predominant clinical features were motor and sensory system involvement, which is similar to studies from Northwest India. We conclude that pain is a major symptom compared to similar studies from other Indian regions and as found in other cross-cultural studies. We also sugest measures to improve the current scenario in India.

Keywords: Multiple sclerosis, Pain, Quality of Life.

How to cite this article: Thomas P, Kumar S, Kumar A. Pain in Multiple Sclerosis: A South Indian Experience. J Recent Adv Pain 2015;1(1):8-12.

Source of support: Nil

Conflict of interest: None


 
Editorial 3
Mayank Chansoria

Opioid Receptors in Pain Management: Past, Present and Future

[Year:2015] [Month:May-August] [Volumn:1 ] [Number:1] [Pages:63] [Pages No:5-7][No of Hits : 641]


ABSTRACT

Opioids play a unique role in society. They are widely feared compounds, which are associated with abuse, addiction and the dire consequences of diversion; they are also essential medications, the most effective drugs for the relief of pain and suffering. Opium, which is derived from the unripe seed capsules of the opium poppy, Papaver somniferum, has a long history; in fact, opioids have been used and abused by humans for longer than any drug aside from alcohol.1,2


 
CASE REPORT
Vikas S Joshi, Gautam Das, Ravi S Sharma

Unusual Case of Psoas Myofascial Pain Syndrome mimicking Radiculopathy

[Year:2018] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:49] [Pages No:47-49][No of Hits : 485]


ABSTRACT

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


 
ORIGINAL ARTICLE
V Shankar, A Raj, C Chatterjee, A Prasad, A Tiwary

A Study comparing the Analgesic Efficacy of Ultrasound-guided TAP Block vs Laparoscopy-guided TAP Block in Patients undergoing Laparoscopy-assisted Ventral Hernia Repair

[Year:2018] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:49] [Pages No:10-14][No of Hits : 373]


ABSTRACT

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


 
ORIGINAL ARTICLE
Deepak Solanki, Meena Singh

Intravenous Regional Anesthesia: Comparing Efficacy of Magnesium Sulfate and Clonidine as an Adjuvant to Lignocaine for Intraoperative and Postoperative Analgesia

[Year:2018] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:49] [Pages No:19-24][No of Hits : 338]


ABSTRACT

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


 
REVIEW ARTICLE
Ravi S Sharma, Gautam Das

What is the Minimum Knowledge of Pain Medicine needed for Other Specialty?

[Year:2018] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:49] [Pages No:32-35][No of Hits : 336]


ABSTRACT

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


 
ORIGINAL ARTICLE
Vrishali Y Apte, Maya A Jamkar

Comparison of Bupivacaine with Tramadol vs Bupivacaine with Dexamethasone in Supraclavicular Block: A Prospective Randomized Double-blind Study

[Year:2018] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:49] [Pages No:15-18][No of Hits : 327]


ABSTRACT

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


 
CASE REPORT
Bablesh Mahawar, Vivek Mahawar, Malvinder Sahi

Role of Diagnostic Block in S1 Radiculopathy in a Patient of Carcinoma Rectum with Leg Pain

[Year:2018] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:49] [Pages No:44-46][No of Hits : 326]


ABSTRACT

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


 
EDITORIAL
Gurumoorthi Ramasamy, Gautam Das

Evolution of Pain Clinic

[Year:2018] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:49] [Pages No:1-5][No of Hits : 316]


ABSTRACT

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


 
PRACTITIONER'S SECTION
Gaurav Sharma, Samarjit Dey

Trigeminal Neuralgia: Radiofrequency Ablation

[Year:2018] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:49] [Pages No:36-38][No of Hits : 303]


ABSTRACT

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


 
ORIGINAL ARTICLE
M Vijay Anand, Vanathi Nachimuthu, Gurumoorthi Ramasamy

A Prospective Comparative Study of ntrathecal 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

[Year:2018] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:49] [Pages No:6-9][No of Hits : 293]


ABSTRACT

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


 
CASE REPORT
Ravi S Sharma, Gautam Das, Palak Chavda, DR Suyashi

Atypical Cases of Internal Disk Disruption mimicking Radiculopathy: A Case Series Study

[Year:2018] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:49] [Pages No:39-43][No of Hits : 272]


ABSTRACT

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


 
ORIGINAL ARTICLE
Pavana Nagaraj, Gautam Das, Ravi S Sharma, Snehil Gupta

Is Major Depression More Commonly associated with Widespread Pain? A Cross-sectional Study to identify Any Relation

[Year:2018] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:49] [Pages No:25-31][No of Hits : 263]


ABSTRACT

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


 
CASE REPORT
Anuja Bhargava, Charu Singh, Mohd. Shakeel, Zeba Siddiqi, Sachin Khanduri, Ekta Agarwal, Rohit Gupta

Rhinolith–A Rare Cause of Sunct Syndrome: A Case Report

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:64-65][No of Hits : 62]


ABSTRACT

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a rare cause of unilateral headaches affecting predominantly males in usually the fifth decade. The pain is usually moderate to severe in intensity affecting the ocular and the periocular area. The mean duration of paroxysms is 1 minute, with a range of 5 to 250 seconds. A 25-year-old male complained of progressive unilateral left nasal obstruction for 8 months along with ipsilateral daytime headache predominantly in the periocular and temporal region, conjunctival injection, tearing and minimal eyelid edema. The patient was admitted and kept under observation for the reported symptoms. Nasal endoscopy and probing revealed a greenish/ dirty grey and gritty mass filling posterior part of the left nasal cavity at the time of a headache, there was right sided ipsilateral congestion in the conjunctiva, lacrimation minimal and periorbital edema neurological examination of the patient was normal. The patient was posted for endoscopic rhinolith removal followed by infundibulotomy and maxillary sinusotomy. At 3 week follow-up, the patient was relieved of all symptoms and required no medication. The patient was asymptomatic at 6 week and 6 months follow up. Thus a diagnosis of secondary SUNCT cause rhinolith was confirmed which resolved with rhinolith removal.

Key words: Headache, Rhinolith, Sunct syndrome

How to cite this article: Bhargava A, Singh C, Shakeel M, Siddiqi Z, Khanduri S, Agarwal E, Gupta R. Rhinolith—A Rare Cause of Sunct Syndrome: A Case Report. J Recent Adv Pain 2018; 4(2):64-65.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Bhavita Panjwani, Gautam Das, Leno Ninan Jacob, Abhisesh Shrestha

Platelet-rich Plasma in Plantar Fasciitis: A Review

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:57-59][No of Hits : 51]


ABSTRACT

Aim: The aim of this review is to help decide outcome of patients in whom platelet-rich plasma (PRP) has been used and whether it can be used as an effective treatment in plantar fasciitis.

Introduction: Plantar fasciitis is a very common complaint for which patients see a pain physician. Plantar fasciitis is self-limiting and up to 90% patients recover by conservative treatment. Previously all treatments focused on decreasing inflammation, e.g., use of non-steroidal anti-inflammataory drugs (NSAIDs) and corticosteroid injections. Newer modalities of treatment target decreasing degeneration caused by the disease process. These treatments initiate an inflammatory reaction which restarts the healing process.2 These include PRP injections, extra corporeal shock wave therapy (ESWT), etc.

Review results: We screened 18 full text studies based on our searches, Out of these 1 was a meta-analysis of randomised control trials (RCTs), 3 were RCTs and remaining were level 3 cohort studies. These included studies done from 2011 till date. Our review inferred that PRP therapy decreases pain and helps in improving quality of life in patients with recalcitrant plantar fasciitis.7

Conclusion: Use of PRP in Chronic Plantar fasciitis is effective. It improves long term outcomes, decreasing chances of recurrences.

Keywords: Plantar fasciitis, PRP, Chronic

How to cite this article: Panjwani B, Das G, Jacob LN, Shrestha A. Platelet-rich in Plantar Fasciitis: A Review. J Recent Adv Pain 2018;4(2):57-59.

Source of support: Nil

Conflict of interest: None


 
PRACTITIONER'S SECTION
Ronnie Kaddu, Gautam Das, Karthik K

Piriformis Injection in Pain Management

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:60-63][No of Hits : 51]


ABSTRACT

Introduction: Piriformis syndrome is an uncommon cause of unilateral lower limb pain that is as a result of sciatic nerve compression by the piriformis muscle. Symptoms associated with this syndrome often make it difficult to distinguish it from several other conditions that lead to buttock, thigh or leg pain. Despite a number of clinical signs suggestive of a piriformismyofascial disorder, not all patients present with the typical clinical features. This probably explains why it is frequently left undiagnosed. The piriformis injection should be considered when symptoms persist after attempts have been made with conservative methods. It is simple and fast and does not require a lot of needle manipulation. The technique for needle placement uses fluoroscopic guidance to inject the piriformis muscle with local anesthetic and can be used for both diagnostic and therapeutic purposes.

Keywords: Leg pain, Piriformis injection, Piriformis syndrome

How to cite this article: Kaddu R, Das G, Karthik K. Piriformis Injection in Pain Management. J Recent Adv Pain 2018;4(2):60-63.

Source of support: Nil

Conflict of interest: None


 
EDITORIAL
Mayank Chansouria, Peeyush Shivhare

Role of USG in Musculoskeletal pain and its Future perspective

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:51-52][No of Hits : 50]


ABSTRACT

Over past two decades, musculoskeletal ultrasonography (MSK USG) has established itself as a versatile and precise imaging modality in the fields of radiology, sports medicine,rheumatology and pain medicine. It has become increasingly popular and, without doubt, has become an imaging modality of great value in the diagnosis of MSK disorders. In fact, it has gained its rightful place in literature, along with magnetic resonance imaging (MRI).

How to cite this article: Chansouria M, Shivhare P. Role of USG In Musculoskeletal pain and its Future perspective. J Recent Adv Pain 2018;4(2):51-52.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Rajeev Harshe

Prolonged Coccydynia with Discogenic Low Back Pain Relieved by Hypodermic Needling– A Novel, Economical, Safe and Effective Technique.

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:82-83][No of Hits : 45]


ABSTRACT

Pain at tailbone-coccydynia is a nagging pain. The patient finds it difficult to sit straight and give pressure on the coccyx. This is generally seen after trauma on the coccyx. This does disturb the quality of life. Similarly, discogenic low back pain is very common.
Local injection at coccyx in the form of cortisone, caudal epidural with or without ganglion impar block is a commonly used method to treat this pain. There are many instances when these treatments also do not relieve pain.
Herewith, I am presenting a case where a patient with refractory coccydynia with discogenic low back was given the treatment of hypodermic needling and patient-reported significant pain relief.
This technique is based on the concept of stimulating A beta fibers present in the subcutaneous region and attempting to release endorphins into the segmental dorsal horn. Simple hypodermic needles number 26 gauge half inch length is used to be put in the subcutaneous area of respective sclerotomes.

Keywords: Acupuncture, Coccydynia, Coccyx pain, Low back pain, Needling, Pain at tail bone

How to cite this article: Harshe R. Prolonged Coccydynia with Discogenic Low Back Pain Relieved by Hypodermic Needling - A Novel, Economical, Safe and Effective Technique. J Recent Adv Pain 2018;4(2):82-83.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Praneet Singh, Gautam Das, Ronnie P Kaddu

Radiofrequency Lesioning of Rami Communicans for Discogenic Back Pain: Is Failure Inevitable? A Case Report

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:84-86][No of Hits : 45]


ABSTRACT

Internal disc disruption is the most common cause of low back pain amongst the younger adults. It is characterized by diffuse axial back pain with or without non-dermatomal leg pain limited up to knee usually. Presence of hyper-intense zone in magnetic resonance imaging (MRI), provocative discography and rami communicans block is the current diagnostic modalities. Radiofrequency ablation of the rami communicans is one of the therapeutic options in cases which are resistant to other treatment modalities. However, many a time it has been found that in spite of significant pain relief achieved with diagnostic rami communicans block with local anesthetics, conventional radio frequency procedures may give unsuccessful outcomes. We hereby discuss a similar case scenario with possible explanations based on literature.

Keywords: Discogenic back pain, Rami communicans block, innervation of disc, Sinuvertebral nerve

How to cite this article: Singh P, Das G, Kaddu RP. Radiofrequency lesioning of Rami Communicans for Discogenic Back Pain: Is Failure Inevitable? A Case Report. J Recent Adv Pain 2018;4(2):84-86.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Pratibha Matche, Kavya H, CL Gurudutt

Pain Management with IV and Oral Ketamine in a Child with Acute on Chronic Pancreatitis: Old Wine in New Bottle–A Case Report

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:66-68][No of Hits : 44]


ABSTRACT

A 13-year-old male child, a known case of chronic pancreatitis with acute exacerbation, presented with severe abdominal pain. The pain was dull aching type associated with burning sensation present all over the abdomen with VAS score-9/10. He was treated with paracetamol, Non-steroidal anti-inflammatory drugs, and opioids. Despite this multimodal analgesia, he had inadequate pain relief. Since the child exhibited both nociceptive and neuropathic elements, ketamine was considered as the analgesic of choice. He was successfully treated with subanesthetic low dose intravenous (IV) ketamine infusion followed by oral ketamine therapy for 15 days till he underwent proposed surgery. We have been unable to find any previous reports of oral ketamine use for this condition.

Keywords: Acute pain, Chronic pancreatitis, Ketamine, Neuropathic pain, Oral administration, Pediatric pain

How to cite this article: Matche P, Kavya H, Gurudutt CL. Pain Management with IV and Oral Ketamine in a Child with Acute on Chronic Pancreatitis : Old Wine in New Bottle-A Case Report. J Recent Adv Pain 2018;4(2):66-68.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Meena Singh, Mamta Mahobia, Rajesh Mishra, Vaibhv Maheshwari

Lumber Plexus Block for Postoperative Analgesia: Effect of Adding Low Dose Dexmedetomidine to Ropivacaine

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:53-56][No of Hits : 43]


ABSTRACT

Introduction: Our aim is to assess the effect of adding 0.5μg/ kg dexmedetomidine to 0.33% ropivacaine in lumbar plexus block (LPB) on postoperative analgesia and opioid consumption. This dose and concentration has not been used in LPB in previous studies.

Materials and methods: This study enrolled 60 patients scheduled for hip surgery to receive either 32 mL of study drug which consisted of 30mL of ropivacaine 0.33% and 2 mL of Normal saline [Group RN (n = 30)] or 30 mL solution, in which dexmedetomidine 0.5 μg/kg was diluted in normal saline to reach a total volume of 2 mL and added to 30 mL of ropivacaine 0.33% Group RD (n = 30) before induction of general anesthesia. Postoperative analgesia was assessed with visual analog scale (VAS) scoring at 0,2,4,8,12,18,24 hours and patient satisfaction score(PSS) at 24 hour. Hemodynamic parameters were monitored perioperatively. Mann-Whitney U-test was applied for VAS and sedation scores. Unpaired t-test was applied for age, weight, duration of surgery and duration of post operative analgesia.

Results: Sixty patients were analyzed. There was significant reduction in pain scores in Group RD compared to RN upto 8 hours postoperatively. Duration of analgesia was significantly increased in Group RD, 502 ± 102 as compared to Group RN, 250 ± 116. Total analgesic requirement in form of opioid was also reduced by dexmedetomidine in first 24-hour. There was no difference in hemodynamic parameters and sedation scores throughout the study among both groups with nil complication.

Conclusion: Low dose dexmedetomidine as an adjuvant to ropivacaine prolongs the time for first analgesic requirement and reduces the total postoperative opioid consumption without major side effects.

Clinical significance: Limiting the dose of dexmedetomidine 0.5 μg/kg and ropivacaine concentration to 0.33% in combination, not only prolong duration of analgesia but also avoid undesirable side effects.

Keywords: Dexmedetomidine, Lumbar plexus block, Postoperative analgesia

How to cite this article: Singh M, Mahobia M, Mishra R, Maheshwari V. Lumber Plexus Block for Postoperative Analgesia: Effect of Adding Low Dose Dexmedetomidine to Ropivacaine. J Recent Adv Pain 2018;4(2):53-56.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Praneet Singh, Gautam Das, Palak Chavda, Abhisesh Shrestha

A Case Report on Lumbar Synovial Cyst: An Uncommon Presentation

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:79-81][No of Hits : 43]


ABSTRACT

Lumbar synovial cyst, though rare, can mimic many other conditions including lumbar radiculopathy or neurogenic claudication and therefore should be included in the differential diagnosis for radiculopathy, especially in elderly patients. Here we discuss our experience with a postoperative case of transpedicular screw fixation presenting with typical features radiculopathy and claudication symptoms caused by a lumbar synovial cyst, its diagnosis and successful management of the neurological symptoms.

Keywords: Nerve root compression, Spine surgery, Synovial cyst

How to cite this article: Singh P, Das G, Chavda P, Shrestha A. A Case Report on Lumbar Synovial Cyst: An Uncommon Presentation. J Recent Adv Pain 2018;4(2):79-81.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Amit A Sequeira, Gautam Das, Karan Patel

A Rare Case of Diffuse Idiopathic Skeletal Hyperostosis with Stable Burst Fracture of D12 Vertebra Presenting with Low Back Pain: A Case Report

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:69-74][No of Hits : 42]


ABSTRACT

Diffuse idiopathic skeletal hyperostosis (DISH) is a relatively poorly studied disease in the Indian population. The characteristic radiologic findings of this disorder are the presence of “flowing ossification“ especially along the anterolateral borders of the vertebral bodies. Trivial trauma, especially involving hyperextension of the spine, can lead to vertebral fractures, sometimes with serious neurological deficits. We present a case of DISH involving fracture of D12 and L1 vertebrae, following a minor fall at home, which was managed conservatively due to multiple risk factors for surgery. The patient presented to our pain clinic with signs and symptoms suggestive of the lower lumbar facet and bilateral sacroiliac joint arthropathy, without any features of D12, L1 fracture or any neurological deficits. We postulate that the lower lumbar and SI pathology could be a sequel of the orthotic support used in the conservative management of DISH in this patient or a natural progression of the disease.

Keyword: Burst fracture, DISH, Flowing ossification

How to cite this article: Sequeira AA, Das G, Patel K. A Rare Case of Diffuse Idiopathic Skeletal Hyperostosis with Stable Burst Fracture of D12 Vertebra presenting with Low Back Pain: A Case Report. J Recent Adv Pain 2018;4(2):69-74.

Source of support: Nil

Conflict of interest: None


 
LETTER TO EDITOR
Sachin Upadhyay, Pushpraj Patel

Bipolar Radiofrequency Ablation of Genicular Nerves in Patients with Pacemaker

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:87][No of Hits : 39]


ABSTRACT

We read with great interest the recently published case report1 entitled “Bipolar Radiofrequency Ablation of Genicular Nerves in Patients with Pacemaker”. Radiofrequency ablation of genicular nerves seems to be a safe and effective for chronic knee osteoarthritis (OA) patients with a favorable response to diagnostic block. Although we applaud the work, we wish to draw the attention of the author to certain critical points which need to be clarified.


 
CASE REPORT
Karan M Patel, Gautam Das, Amit A Sequeira, Praneet Singh

Imagining findings can be misleading; clinical correlation is must: A Rare case of Spinal Cord A-V Malformation Masquerading Radiculopathy

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:75-78][No of Hits : 35]


ABSTRACT

Spinal dural arteriovenous fistulas (SDAVF), is a clinical condition that can pose a challenge to the clinicians both in the diagnosis as well as treatment. This rare disorder can present with certain nonspecific symptoms and signs, including gait abnormality or lower-limb sensory or motor weakness. Symptoms may progress gradually or in some cases decline over a period. It can be treated surgically or through an endovascular approach involving disconnection of the fistula to make a prompt diagnosis, detailed history and proper neurological examination along with correlated imagine findings is the right way. We encountered a patient having long-standing bilateral lower limb weakness and sensory disturbances for which he was operated twice at different levels, with partial improvement. By a combination of detailed neurological examination and appropriate diagnostic imaging, we concluded that an arteriovenous (AV) malformation at the mid-thoracic spinal cord level was the causative factor for the same which is proposed below.

Keywords: Clinical examination, Fistula, Spinal cord AV malformation.

How to cite this article: Patel KM, Das G, Sequeira AA. Singh P. Imagining findings can be misleading, clinical correlation is must: A rare case of Spinal Cord A-V Malformation Masquerading Radiculopathy. J Recent Adv Pain 2018;4(2):75-78.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Mayur Gupta, Lopa H Trivedi, Deepshikha C Tripathi, Palak Chavda

Comparison of Diclofenac Patch and Intramuscular Diclofenac for Postoperative Analgesia in Abdominal Hysterectomy under Spinal Anesthesia: A Prospective, Randomized Clinical Study

[Year:2017] [Month:September-December] [Volumn:3 ] [Number:3] [Pages:41] [Pages No:113-118][No of Hits : 451]


ABSTRACT

Introduction: Immediate postoperative period is very crucial and pain is maximum during first 24 hours. If patients are kept pain free during this period, it leads to vitally stable postoperative period, which in turn leads to early recovery. The aim of this study was to compare the analgesic efficacy of diclofenac sodium via two different routes, intramuscular (IM) and transdermal, in the management of postoperative pain.

Materials and methods: After informed written consent, 60 patients of American Society of Anesthesiologists (ASA) grades ² to III scheduled for abdominal hysterectomy under subarachnoid blockade were randomized into two groups. Group TP (n = 30) received transdermal diclofenac patch 3 hours before surgery and group IM (n = 30) received IM diclofenac sodium 30 minutes before the end of surgery. Transdermal or IM diclofenac was repeated 12 hours later. Postoperative visual analog scale (VAS) scores, hemodynamic data, requirement of rescue analgesic, patient satisfaction, and adverse reaction if any were recorded every 2 hourly over 24 hours period. If VAS values were >4, 2 mg/kg tramadol was given intravenously as rescue analgesia.

Results: Postoperative VAS, hemodynamic data, requirement of rescue analgesia, and patients’ satisfaction were comparable in both the groups (p > 0.05). Intramuscular diclofenac has more side effects.

Conclusion: Diclofenac transdermal patch provided postoperative pain relief as effectively as IM diclofenac for abdominal hysterectomy, without any significant side effects.

Keywords: Diclofenac, Intramuscular, Postoperative pain and analgesia, Transdermal.

How to cite this article: Gupta M, Trivedi LH, Tripathi DC, Chavda P. Comparison of Diclofenac Patch and Intramuscular Diclofenac for Postoperative Analgesia in Abdominal Hysterectomy under Spinal Anesthesia: A Prospective, Randomized Clinical Study. J Recent Adv Pain 2017;3(3):113-118.

Source of support: Nil

Conflicts of interest: None


 
ORIGINAL ARTICLE
Vivek S Chawathe, Amit S Mhambre, Anil K Gaur, Vivek J Pusnake, Rajendra Sharma, Nima I Wangdi

Prevalence of Pain in Medical Representatives using Two-wheeler for Daily Commute

[Year:2017] [Month:May-August] [Volumn:3 ] [Number:2] [Pages:51] [Pages No:61-65][No of Hits : 436]


ABSTRACT

Aim: To investigate the prevalence of pain in medical representatives exposed to two-wheeler riding compared with medical representatives using other modes of commuting.

Materials and methods: A total of 105 medical representatives participated in the study with history of exposure to traveling of at least 300 minutes per week with at least 60 minutes per day for 5 days a week for more than 1 year. Fifty-two of them traveled by two-wheelers and were grouped under “twowheeler group” and 53 were grouped under “control group” as they used bus, train, or car (not self-driven) as a mode of commute. The prevalence and intensity of pain was assessed by Numeric Rating Scale (NRS) for baseline pain and worst pain, Pain Disability Index (PDI), and the Pain diagram for the pain observed during last 2 weeks.

Results: Statistically significant difference was observed in pain levels between the two groups (two-wheeler group vs control group): Numeric Rating Scale baseline pain (p = 0.0315), NRS worst pain (p = 0.0388), and PDI (p = 0.010). The pain scores of the two-wheeler group showed positive dose-response relation with time of exposure to riding. The pain distribution pattern between two-wheeler group vs control group was quiet different with lower back pain 36 vs 23% and ankle foot pain 2 vs 12%.

Conclusion: The study concludes that medical representatives traveling using two-wheelers as compared with bus, train, or car suffer from more cumulative trauma.

Clinical significance: Two-wheeler users have significantly higher prevalence of pain and pain-associated disability due to cumulative trauma disorder, which warrants further studies to improve the depth of our understanding about cumulative traumas.

Keywords: Cumulative trauma disorders, Ergonomics, Low back pain, Medical representative, Riders, Two-wheeler users.

How to cite this article: Chawathe VS, Mhambre AS, Gaur AK, Pusnake VJ, Sharma R, Wangdi NI. Prevalence of Pain in Medical Representatives using Two-wheeler for Daily Commute. J Recent Adv Pain 2017;3(2):61-65.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Depinder Kaur, Harshita Surange, Pankaj N Surange, Saurabh Anand, Amit Choudhary, Suchitra Malhotra

Ultrasound-guided Supraclavicular Nerve Block In-plane Technique: Comparison of Conventional vs Skin Wheal Standoff Technique

[Year:2017] [Month:January-April] [Volumn:3 ] [Number:1] [Pages:57] [Pages No:25-29][No of Hits : 362]


ABSTRACT

Introduction: The foremost advantage of ultrasound-guided peripheral nerve blocks is visualization of anatomical structures of interest and then depositing the local anesthetic for block. Supraclavicular block is the very commonly used block for upper limb surgeries.

Aim: The aim of our study is that for greater efficacy and safety of our blocks, we should use a technique in which we are not only visualizing the anatomical structures, but also the complete needle path and ultimately the deposition of local anesthetic in the vicinity of nerves and having a safe distance from adjacent structures like vessels and pleura.

Materials and methods: A total of 60 patients were accepted for study and divided into two groups of 30 each randomly. In group I, ultrasound-guided supraclavicular nerve block was given with skin wheal oblique standoff technique and in group II, the usual technique. Both the groups were compared in terms of better needle visualization, number of attempts, and success of block.

Results: In group I, we were able to visualize the complete path of needle in 70% of cases in first attempt as compared with group II in 40% of cases. In group I, 70% of blocks were placed in the first attempt as compared with 33% in group II. The p-value was <0.005 and difference was statistically significant. Similarly, operator fatigue, time for block placement, and corner pocket visualization were better in group I.

Conclusion: We have an opinion and recommendation from this study that by simple modification of the usual technique of giving supraclavicular block, i.e., raising a skin wheel, we can achieve greater success with our procedure.

Keywords: Oblique standoff technique, Supraclavicular block, Ultrasound.

How to cite this article: Kaur D, Surange H, Surange PN, Anand S, Choudhary A, Malhotra S. Ultrasound-guided Supraclavicular Nerve Block In-plane Technique: Comparison of Conventional vs Skin Wheal Standoff Technique. J Recent Adv Pain 2017;3(1):25-29.

Source of support: Nil

Conflict of interest: None


 
EDITORIAL
Dipasri Bhattacharya

New Insights in Chronic Pelvic Pain

[Year:2017] [Month:September-December] [Volumn:3 ] [Number:3] [Pages:41] [Pages No:111-112][No of Hits : 349]


ABSTRACT

Chronic pelvic pain (CPP) is most commonly defined as continuous or intermittent pain that occurs in pelvis, anterior abdominal wall at or below the umbilicus, lumbosacral back, or buttocks, with a duration for 6 or more months, sufficient to cause functional disability to seek medical care.1 Chronic pelvic pain is more prevalent in females, with an estimated worldwide prevalence of 2.1 to 24%.2 Two-thirds of patients with CPP do not carry a definitive diagnosis.3,4

How to cite this article: Bhattacharya D. New Insights in Chronic Pelvic Pain. J Recent Adv Pain 2017;3(3):111-112.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Krishnagopal Vinod, Pranjali Kuhrekar, Krishnakumar Sharanya, Raghuraman MS

Study on evaluating the Adequacy of Psoas Compartment Block and Sacral Plexus Block for Lower Limb Surgeries

[Year:2017] [Month:May-August] [Volumn:3 ] [Number:2] [Pages:51] [Pages No:66-70][No of Hits : 348]


ABSTRACT

Background: To evaluate the adequacy of combined psoas and sacral plexus block (SPB) as a sole anesthetic agent, patients’/ surgeons’ satisfaction, perioperative urinary retention, and duration of postoperative analgesia for unilateral lower limb surgeries.

Materials and methods: A single-center prospective study was conducted between March and August 2016 on 101 patients undergoing elective unilateral lower limb surgeries under combined psoas and SPB belonging to American Society of Anesthesiologists physical status 1 and 2, aged between 18 and 60 years. Adequacy of block, patients’/surgeons’ satisfaction, perioperative urinary retention, and duration of postoperative analgesia were noted.

Results: Among the 101 patients, 1 patient was excluded from the study. In 93 patients (93%), the block was adequate. Among the patients with adequate block, the surgeons’ and patients’ satisfaction was 95.7 and 96.8% respectively. Eight patients were catheterized preoperatively and rest of the 92 patients (100%) voided spontaneously without any intervention. The average time of first analgesic dose was 347.7 ± 103.7 min.

Conclusion: Combined psoas and SPB is a good and a safe alternative to neuraxial block in patients undergoing unilateral lower limb surgeries with good surgeon and patient satisfaction, lesser incidence of urinary retention, and prolonged postoperative pain relief.

Keywords: Postoperative urinary retention, Psoas compartment block, Sacral plexus block.

How to cite this article: Vinod K, Kuhrekar P, Sharanya K, Raghuraman MS. Study on evaluating the Adequacy of Psoas Compartment Block and Sacral Plexus Block for Lower Limb Surgeries. J Recent Adv Pain 2017;3(2):66-70.

Source of support: Nil

Conflict of interest: None


 
BRIEF COMMUNICATION
Sunny Malik, Gautam Das, Arun Puri, Shraddha Malik, Vikky Jaiswal

Opioid-induced Hyperalgesia: An Entity not so Common, but exists

[Year:2017] [Month:January-April] [Volumn:3 ] [Number:1] [Pages:57] [Pages No:54-55][No of Hits : 347]


ABSTRACT

Reported are cases of opioid-induced hyperalgesia (OIH) which is a rare entity to be seen by pain physicians. It occurs in patients treated with long term opioids which is perceived in the form of hyperalgesia or allodynia. It is a clinical challenge to treat such cancer patients and opioid addict individuals. The understanding of OIH mechanism, manifestations as well as treatment is important for any pain physician.

Keywords: Allodynia, Hyperalgesia, Opioid.

How to cite this article: Malik S, Das G, Puri A, Malik S, Jaiswal V. Opioid-induced Hyperalgesia: An Entity not so Common, but exists. J Recent Adv Pain 2017;3(1):54-55.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL RESEARCH
Suman Gupta, Sandhya Kashyap, Abhay S Bhadauria, Bhanu Choudhary

Preemptive Local Infiltration of 0.5% Levobupivacaine HCl vs 0.5% Ropivacaine HCl for Postoperative Pain Control in Lumbar Laminectomy Patients

[Year:2017] [Month:January-April] [Volumn:3 ] [Number:1] [Pages:57] [Pages No:30-35][No of Hits : 344]


ABSTRACT

Introduction: Achieving effective postoperative analgesia in postlaminectomy patients is a cumbersome task for the anesthesiologist. The need is to provide effective analgesia with minimal systemic side effects, cost-effectively, as laminectomy surgeries are associated with paramount postoperative pain. The purpose of this study was to compare the effectiveness of preemptive local infiltration of 0.5% levobupivacaine HCl vs 0.5% ropivacaine HCl for postoperative pain control in lumbar laminectomy patients.

Materials and methods: A total of 96 patients who were scheduled to undergo elective lumbar laminectomy were included in the study. Patients were randomly allocated to three groups. In groups I, II, and III, incisional site was infiltrated with 20 mL of 0.5% levobupivacaine HCl, 20 mL of 0.5% ropivacaine HCl, and 20 mL of 0.9% normal saline respectively. Demographic data, vital parameters, postoperative visual analog scale (VAS) scores, and total tramadol consumption were recorded.

Results: Time to first rescue analgesia was earliest in group III (8.72 ± 6.19 minutes), followed by group II (155 ± 39.53 minutes) and group I (208 ± 27.02 minutes) (p < 0.05). Group I has least total consumption of tramadol (253.1 ± 50.78 mg) at the end of 24 hours postoperatively when compared with group II (312.50 ± 33.60 mg) and group III (396.8 ± 40 mg) (p < 0.05). The overall VAS score in 24 hours was significantly lower in group I as compared with groups II and III. No significant adverse effects of local wound infiltration were observed.

Conclusion: This study suggests that preemptive infiltration of the incision site with levobupivacaine provides significantly better postoperative analgesia with minimal side effects.

Keywords: Central sensitization inhibition, Local infiltration, Lumbar laminectomy, Postoperative analgesia, Preemptive analgesia, Preincisional, Tramadol.

How to cite this article: Gupta S, Kashyap S, Bhadauria AS, Choudhary B. Preemptive Local Infiltration of 0.5% Levobupivacaine HCl vs 0.5% Ropivacaine HCl for Postoperative Pain Control in Lumbar Laminectomy Patients. J Recent Adv Pain 2017;3(1):30-35.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Palak Chavda, Gautam Das, Ravi S Sharma

An Unusual Case of Lumbar Facet Arthropathy presenting with Pain Abdomen

[Year:2017] [Month:September-December] [Volumn:3 ] [Number:3] [Pages:41] [Pages No:142-144][No of Hits : 337]


ABSTRACT

Introduction: Facet joint arthropathy refers to a degenerative disease that affects the joints of the vertebrae. Lumbar facet joints (zygapophyseal joint) were first suggested in the medical literature as a source of low back pain (LBP) and lower extremity pain in 1911. These joints have been implicated as the cause of pain in 15 to 45% of patients with chronic LBP. The majority of published clinical investigations report no correlation between the clinical symptoms of LBP and degenerative spinal changes observed on radiologic imaging studies, including radiographs, magnetic resonance imaging (MRI), computed tomography (CT), single photon emission CT, and radionuclide bone scanning. Low back pain from the facet joints often radiates down into the buttocks and down the back of the upper leg. Pain is rarely present in the front of the leg or below the knee. Our case report is about a 24-year-old female patient who presented with left-sided paramedian LBP with severe lower abdominal pain, who underwent several investigations for her abdominal pain and was treated for abdominal pain without any significant relief. Careful history and clinical examination revealed lumbar facet joint tenderness involving left L4-L5 and L5-S1 facet joint. Diagnostic block followed by radiofrequency (RF) ablation of medial branch supplying the corresponding facet joint was performed with near-complete pain relief.

Keywords: Diagnostic block, Facet joint, Zygapophyseal joint.

How to cite this article: Chavda P, Das G, Sharma RS. An Unusual Case of Lumbar Facet Arthropathy presenting with Pain Abdomen. J Recent Adv Pain 2017;3(3):142-144.

Source of support: Nil

Conflict of interest: None


 
PRACTITIONER'S SECTION
Praneet Singh, Gautam Das, Nagarajan Nagalingam

Cervical Epidural Steroid Injection in Pain Management

[Year:2017] [Month:September-December] [Volumn:3 ] [Number:3] [Pages:41] [Pages No:136-139][No of Hits : 327]


ABSTRACT

Introduction: Interventions in pain management hold an important aspect in diagnosing as well as treating patients in today’s practices. Knowing proper procedural technique is an important aspect for a pain practitioner to avoid complications. Each individual patient is not the same, thus producing a challenge for any pain intervention. In this article, we discuss the standard procedure of cervical epidural, contralateral interlaminar approach with its complications and troubleshooting

Keywords: Cervical epidural steroid, Interventions, pain management.

How to cite this article: Singh P, Das G, Nagalingam N. Cervical Epidural Steroid Injection in Pain Management. J Recent Adv Pain 2017;3(3):136-139.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Atish Pal, Chitra Chatterji, Chetan Mehra, Varadarajan Muralidhar, Harsha Madhok

Comparative Evaluation of Intra-articular Bupivacaine vs Intra-articular Bupivacaine and Dexmedetomidine for Postoperative Analgesia in Arthroscopic Knee Surgery

[Year:2017] [Month:May-August] [Volumn:3 ] [Number:2] [Pages:51] [Pages No:71-76][No of Hits : 314]


ABSTRACT

Aim: To assess the postoperative analgesic effect of intraarticular dexmedetomidine, when administered as an adjuvant with bupivacaine in arthroscopic knee surgeries.

Materials and methods: A total of 60 patients undergoing elective unilateral knee arthroscopy under general anesthesia were randomly assigned to two groups (n = 30). Group Bupivacaine and Saline (BS) received intra-articularly 19 mL of 0.5% bupivacaine and 1 mL of isotonic saline (total volume 20 mL). Group Bupivacaine and Dexmedetomidine (BD) received intra-articular 100 μg dexmedetomidine (1 mL) added to 19 mL of 0.5% bupivacaine. Pain assessment using visual analog scale (VAS) was done at regular intervals for 24 hours and rescue analgesia given accordingly.

Results: Increased VAS scores (p-value 0.005, <0.001, 0.002) and increased use of supplementary analgesic (p-value 0.042, 0.026, 0.024) were seen in group BS (control group) compared with group BD (study group), at intervals of 30 minutes, 1 hour, and 2 hours. Mean duration of analgesia (time for first analgesic requirement) was longer in group BD (median 4 hours) compared with BS (median 1 hour) (p-value 0.012).

Conclusion: Intra-articular dexmedetomidine administered as an adjuvant to bupivacaine improves the quality and duration of postoperative analgesia after knee arthroscopy.

Clinical significance: A myriad of agents have been studied for their potential use in attenuating postoperative pain following knee arthroscopy, but despite multiple studies with various agents, no single agent has been found to be clearly superior to the rest. In such a scenario, dexmedetomidine provides an interesting option.

Keywords: Arthroscopy, Bupivacaine, Dexmedetomidine, Intra-articular, Postoperative pain.

How to cite this article: Pal A, Chatterji C, Muralidhar V, Mehra C, Madhok H. Comparative Evaluation of Intraarticular Bupivacaine vs Intra-articular Bupivacaine and Dexmedetomidine for Postoperative Analgesia in Arthroscopic Knee Surgery. J Recent Adv Pain 2017;3(2):71-76.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Tasrif Hamdi, Ravi S Sharma, Gautam Das, Pradipta Barik

Management of an Atypical Case of Recurrent Trigeminal Neuralgia, switching from V2 to V3 Division: A Case of Resistant Trigeminal Neuralgia

[Year:2017] [Month:May-August] [Volumn:3 ] [Number:2] [Pages:51] [Pages No:108-110][No of Hits : 293]


ABSTRACT

Trigeminal neuralgia (TN) is a neuropathic pain syndrome characterized by severe unilateral paroxysmal facial pain. Pain attacks are usually stimulated by tactile irritation within the region of the trigeminal nerve.Trigeminal neuralgia pain typically remits and relapses, even when patients are on conventionally used treatments, resulting in a major source of disability and poor quality of life. Multiple forms of treatment are available for its management, but it is often resistant to conventional treatments. Radiofrequency (RF) ablation is one of the best treatment modalities to relieve pain in TN but even after successful RF ablation of Gasserian ganglion, there may be relapses. Rarely, patient may present with pain in other distributions of trigeminal nerve. We report a case of a 55-year-old female having relapsing form of TN, switching from V2 to V3 division of trigeminal nerve distribution.

Keywords: Gasserian ganglion, Radiofrequancy ablation, Trigeminal neuralgia.

How to cite this article: Hamdi T, Sharma RS, Das G, Barik P. Management of an Atypical Case of Recurrent Trigeminal Neuralgia, switching from V2 to V3 Division: A Case of Resistant Trigeminal Neuralgia. J Recent Adv Pain 2017;3(2):108-110.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Ravi S Sharma, Gautam Das, Tasrif Hamdi

Case of Difficult Identification of Foramen Ovale: Radiofrequency Ablation of Gasserian Ganglion for Trigeminal Neuralgia Secondary to Squamous Cell Carcinoma in a Posthemimandibulectomy, Hemimaxillectomy Patient

[Year:2017] [Month:May-August] [Volumn:3 ] [Number:2] [Pages:51] [Pages No:105-107][No of Hits : 290]


ABSTRACT

Oral squamous cell carcinoma (SCC) represents 90 to 95% of all malignant neoplasms of the oral cavity. Squamous cell carcinoma occurs in several well-established intraoral sites, including the floor of mouth, tongue, gingiva, lips, and buccal mucosa. It might also present in the tooth-bearing segment of either the maxilla or mandible. We report a case of a 56-yearold female posthemimandibulectomy, hemimaxillectomy patient secondary to SCC involving the maxilla, mandible, and buccal mucosa. Patient presented with chief complaints of electric shock-like sensation along the distribution of trigeminal nerve. These symptoms were aggravated during exposure with cold winds and during conversation. This facial pain was resistant to medications like carbamazepine. So radiofrequency ablation of Gasserian ganglion via foramen ovale was planned. Patient had near-complete relief of symptoms after culmination of the procedure.

Keywords: Gasserian ganglion, Squamous cell carcinoma, Trigeminal neuralgia.

How to cite this article: Sharma RS, Das G, Hamdi T. Case of Difficult Identification of Foramen Ovale: Radiofrequency Ablation of Gasserian Ganglion for Trigeminal Neuralgia Secondary to Squamous Cell Carcinoma in a Posthemimandibulectomy, Hemimaxillectomy Patient. J Recent Adv Pain 2017;3(2):105-107.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Kanthimathy R, Ashok K Durairaj, Ganesh Annamalai

A Prospective Analysis of Ultrasonography-guided Caudal Epidural Steroid in the Management of Chronic Low Back Pain and Radicular Leg Pain

[Year:2017] [Month:September-December] [Volumn:3 ] [Number:3] [Pages:41] [Pages No:119-124][No of Hits : 283]


ABSTRACT

Introduction: Low back pain and sciatica (LBPS) is a major health and socioeconomic problem in modern India. Inadequate treatment of pain leads to loss of valuable man-hours for the country.

Aim: The study aims to validate the effect of ultrasonography (USG)-guided caudal epidural steroid (CES) injection in the management of pain due to LBPS.

Materials and methods: This is a noncomparative clinical study in patients with LBPS due to lower lumbar and sacral nerve root involvement. Under USG guidance caudal epidural space was identified; mixture of local anesthetic and methyl prednisolone is injected as bolus dose; and visual analog scale (VAS) score and straight leg raising test (SLRT) were recorded pre- and postprocedure. Patients are followed up to 6 months for assessing the pain relief.

Results: The mean VAS score before the procedure is 7.78, postprocedure is 2.95. The SLRT before the procedure is 28.58, and the postprocedure is 71.83. Our study showed statistically significant improvement in pain relief and SLRT.

Conclusion: The USG guidance enables us to perform the procedure in real time and helps us to avoid inadvertent vascular deposition of drug. Caudal approach minimizes the possibility of dural puncture. The USG-CES injection is effective in managing the chronic LBPS of lower lumbar and sacral nerve root involvement.

Keywords: Caudal epidural steroid, Disk degenerative disease, Lower back pain and sciatica, Straight leg raising test, Ultrasonogram.

How to cite this article: Kanthimathy R, Durairaj AK, Annamalai G. A Prospective Analysis of Ultrasonographyguided Caudal Epidural Steroid in the Management of Chronic Low Back Pain and Radicular Leg Pain. J Recent Adv Pain 2017;3(3):119-124.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Snehil Gupta, Gautam Das, Amiya Mishra, Abhishek Gupta

Burst Compression Fracture in Ankylosing Spondylitis: A Challenging Case of Vertebroplasty

[Year:2017] [Month:September-December] [Volumn:3 ] [Number:3] [Pages:41] [Pages No:147-150][No of Hits : 282]


ABSTRACT

Ankylosing spondylitis (AS) is a chronic inflammatory joint disease. Osteoporosis and fractures of the vertebral body and its dorsal arch are now well-recognized features because of the altered biomechanics of the ankylosed spine. “Seat belt” or “burst compression” fractures through the disk, juxta-end plate, and posterior segments have been observed very often in the thoracolumbar spine. These are associated with increasing pain with or without neurologic deficit, and may require intervention. Vertebroplasty has proven benefits in the treatment of stable spinal fractures and this technique allows complete or marked pain relief and bone strengthening in most cases. Decision to perform vertebroplasty should be made by a multidisciplinary team. In this case report, we have tried to emphasize on the fragility of the spine that can result from minor injury as well as the management of thoracic vertebral fracture complicating AS.

Keywords: Ankylosing spondylitis, Burst compression fracture, Vertebroplasty.

How to cite this article: Gupta S, Das G, Misra A, Gupta A. Burst Compression Fracture in Ankylosing Spondylitis: A Challenging Case of Vertebroplasty. J Recent Adv Pain 2017;3(3):147-150.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Subhendu Parida, Samarjit Dey

Magnetic Resonance Imaging in Low Back Pain: A Review of Current Recommendations and Its Usefulness in Low Back Pain Evaluation

[Year:2017] [Month:September-December] [Volumn:3 ] [Number:3] [Pages:41] [Pages No:131-135][No of Hits : 271]


ABSTRACT

Magnetic resonance Imaging (MRI) is the additional diagnostic modality in a patient with low back pain. Being a non-invasive and non-radiation modality MRI is preferred to explore the soft tissues of the back. MRI back doesn’t only confirm the diagnosis, but also gives information about the site of pathology and correlation with clinical findings can be done simultaneously. There may be many incidental findings in MRI. On the other hand there are many MRI findings which are not presented clinically but being treated by interventions. We must use MRI as an adjunct of the diagnosis to correlate clinically, not just treat the MRI findings.

Keywords: Facet arthropathy, Low back pain, Lumbar canal stenosis, Magnetic resonance imaging.

How to cite this article: Parida S, Dey S. Magnetic Resonance Imaging in Low Back Pain: A Review of Current Recommendations and Its Usefulness in Low Back Pain Evaluation. J Recent Adv Pain 2017;3(3):131-135.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Vikram I Shah, Sachin Upadhyay, Kalpesh Shah, Ashish N Sheth, Amish Kshatriya, Anivesh Jain, Pankaj Sharma, Jatin G Sanandia

Risk of Falling after Femoral Nerve Block for Total Knee Arthroplasty: Periprosthetic Fractures—A Serious Concern

[Year:2017] [Month:September-December] [Volumn:3 ] [Number:3] [Pages:41] [Pages No:125-130][No of Hits : 254]


ABSTRACT

Objective: Femoral nerve block (FNB) is a popular, minimally invasive postoperative pain management procedure following total knee arthroplasty (TKA). Prolonged motor blockade has been associated with increased risk of fall. The primary objective of the present study was therefore, to evaluate the risk of falling or near falling for FNB in patients who underwent TKA.

Materials and methods: After Institutional Review Board approval, prospective cohort (142) of patients was randomized into two groups: the intervention (FNB as an adjunct to analgesia) vs the control (standard treatment) at our hospital for unilateral primary conventional TKA. The risk of falling as assessed using Tinetti Gait and Balance Instrument and Timed Up and Go (TUG) test was evaluated on the day of hospital discharge, and 1, 2, and 3 months after TKA. All data were collected and critically analyzed and p < 0.05 was considered statistically significant.

Results: Patients in FNB group displayed significant low visual analog scale (VAS) scores than control (p < 0.05). Thirty-seven patients (26.05%) reported falls in the 3 months after surgery. Patients who received FNB following TKA experienced an expected significant worsening of physical function and had increased risk of falling as evaluated by TUG test and Tinetti Gait and Balance Instrument (p < 0.05). Due to unexpected fall, eight patients (28.57%) in FNB group sustained periprosthetic fractures and two patients (22.2%) in control group had opening of arthrotomy. At 3 months, 55 patients in FNB group had reported postoperative neuritis. Significant delay in rehabilitation and early ambulation in patients received FNB, which in turn increases the risk of prolonged hospitalization (p < 0.05).

Conclusion: The Tinetti and gait index and TUG test time showed increased risk of fall for the patients who received FNB owing to substantial functional deficits.

Keywords: Femoral nerve block, Periprosthetic fractures, Timed Up and Go test, Tinetti and gait index, Total knee arthroplasty.

How to cite this article: Shah VI, Upadhyay S, Shah K, Sheth AN, Kshatriya A, Jain A, Sharma P, Sanandia JG. Risk of Falling after Femoral Nerve Block for Total Knee Arthroplasty: Periprosthetic Fractures—A Serious Concern. J Recent Adv Pain 2017;3(3):125-130.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Arthy E Murthy, Gautam Das, Praneet Singh, Nagarajan Nagalingam

Fibromyalgia in Male—Uncommon, but not Rare

[Year:2017] [Month:September-December] [Volumn:3 ] [Number:3] [Pages:41] [Pages No:145-146][No of Hits : 200]


ABSTRACT

Fibromyalgia (FMG) is the most important cause of widespread pain. It is commonly missed out in male patients. We report a case of FMG in a male patient, which is a less common presentation as compared with female patients.

Keywords: Duloxetine, Fibromyalgia, Symptom severity scale score, Widespread pain index.

How to cite this article: Murthy AE, Das G, Singh P, Nagalingam N. Fibromyalgia in Male—Uncommon, but not Rare. J Recent Adv Pain 2017;3(3):145-146.

Source of support: Nil

Conflict of interest: None


 
LETTER TO EDITOR
Chinmoy Roy

Addressing Procedural Pain during Interventional Pain Management

[Year:2017] [Month:September-December] [Volumn:3 ] [Number:3] [Pages:41] [Pages No:151-152][No of Hits : 184]


ABSTRACT

While attempting to alleviate chronic pain, an anxious patient is often subjected to numerous and diverse interventions. This involves injection of contrast material and medicines, to the precise anatomical target, which, in turn, produces significant iatrogenic procedural pain to the patient. Since our primary aim in such procedures remains relief of pain, we should provide an optimal effort to reduce this iatrogenic pain.

How to cite this article: Roy C. Addressing Procedural Pain during Interventional Pain Management. J Recent Adv Pain 2017;3(3):151-152.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Rammurthy Kulkarni, Gautam Das

Management of Chronic Pain in Children

[Year:2016] [Month:September-December] [Volumn:2 ] [Number:3] [Pages:46] [Pages No:99-101][No of Hits : 440]


ABSTRACT

Chronic pain is a common problem not only in adults but also in children. Though there are ample data regarding acute pain and its management in the pediatric age group, information regarding chronic pain in the pediatric population is seriously lacking. Prevalence of chronic pain in children and adolescents varies according to the study and is between 15 and 25%. Chronic pain often interferes with the child’s participation in normal physical, academic, and social activities. Caregivers of children and adolescents with chronic pain suffer a great sense of burden, which affects their emotional, social, and family functioning. The problem is also exacerbated by the additional financial burden secondary to increased physician consultation and medication use. A better understanding of pain in children is needed in order to gain insight into its etiology. Management of chronic pain in this age group requires a multidisciplinary approach as in the adult population. While chronic pain is not well understood, there is emerging evidence that young people and their parents can recover from chronic disability, dependency, and distress and return to a normal life.

Keywords: Adolescents, Children, Chronic pain.

How to cite this article: Kulkarni R, Das G. Management of Chronic Pain in Children. J Recent Adv Pain 2016;2(3):99-101.

Source of support: Nil

Conflict of interest: None


 
Letter-to-the-Editor
Priyanka Dev

Comparison of Suprascapular Nerve Block (A Novel Technique) and a Combination of Suprascapular Nerve Block Plus Intra-articular Injection in Chronic Shoulder Pain

[Year:2016] [Month:January-April] [Volumn:2 ] [Number:1] [Pages:36] [Pages No:36][No of Hits : 433]


ABSTRACT

Dear Sir,
With the increasing number of elderly population, chronic pain is becoming a burning topic of concern. These include: back pain, joint pain, cancer pain, etc. Shoulder pain is one of the chronic pain that affects the population leading to physical as well as mental dissatisfaction among the sufferers.


 
EDITORIAL
Ranabir Pal, Swapan Kumar Paul

Research in Pain Management

[Year:2016] [Month:January-April] [Volumn:2 ] [Number:1] [Pages:36] [Pages No:1-3][No of Hits : 391]


ABSTRACT

Pain is the precise individualized expressed feeling of every human being whether they need relief from it or not. Since time immemorial hundreds of interventions have been recommended for relief of pain. Yet in this new millennium and in the era of “Evidenced-based medicine”, all the managements of need scientific evaluation by applying highest research integrity before they can be adopted as standard treatment protocol.


 
ORIGINAL ARTICLE
Ashutosh Singh, Hariom Khandelwal, Anoop Negi, Bhaskar Dutta, Priyanka Rani

A Prospective Randomized and Double-blind Study to evaluate the Efficacy of Magnesium Sulfate on Postoperative Analgesic Requirement in Patients undergoing Laparoscopic Cholecystectomy

[Year:2016] [Month:May-August] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:49-53][No of Hits : 389]


ABSTRACT

Background and aims: Magnesium sulfate has recently gained popularity as an adjuvant to general anesthesia. It acts as a blocker of N-methyl D-aspartate (NMDA) antagonist and hence may have a potential role in the prevention of postoperative pain. The aim of the present prospective, randomized, double-blind, and placebocontrolled study was to evaluate the efficacy of injection magnesium sulfate 50 mg/kg as premedication upon postoperative pain and analgesic requirement in patients undergoing elective laparoscopic cholecystectomy under general anesthesia.

Materials and methods: After obtaining institutional ethical committee approval, 100 patients of American Society of Anesthesiologists (ASA) grade 1 and 2 undergoing laparoscopic cholecystectomy under general anesthesia were randomly allocated into two groups to receive either 50 mg/kg magnesium sulfate in normal saline to a total volume of 5 mL (group M, n = 50) or 5 mL of normal saline (group S, n = 50) as premedication prior to general anesthesia. The patients were continuously monitored for postoperative pain using visual analog scale (VAS) in the immediate postoperative period and subsequently at 2-hour intervals for the next 24 hours. Injection tramadol 1 mg/kg was given as the rescue analgesic (VAS ≥ 4).

Results: Both the groups were comparable with respect to demographic variables. There was no statistically significant difference in the postoperative VAS scores (p = 0.489) and tramadol requirement among the groups (p = 0.38).

Conclusion: Magnesium sulfate 50 mg/kg premedication is ineffective in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy under general anesthesia.

Keywords: Adjuvants, Analgesia, Magnesium sulfate, N-methyl D-aspartate antagonists, Pain, Postoperative.

How to cite this article: Singh A, Khandelwal H, Negi A, Dutta B, Rani P. A Prospective Randomized and Double-blind Study to evaluate the Efficacy of Magnesium Sulfate on Postoperative Analgesic Requirement in Patients undergoing Laparoscopic Cholecystectomy. J Recent Adv Pain 2016;2(2):49-53.

Source of support: Nil

Conflict of interest: None


 
EDITORIAL
DJMN Rohitha Jayamaha

Comprehensive Pain Care!!.

[Year:2016] [Month:September-December] [Volumn:2 ] [Number:3] [Pages:46] [Pages No:69-71][No of Hits : 376]


ABSTRACT

“Physical pain however great ends in itself and falls away like dry husks from the mind, whilst moral discords and nervous horrors sear the soul.” -Alice James


 
CASE REPORT
Ashok Jadon, Priyanka Jain

Postoperative Cerebrospinal Fluid Leak managed with Transforaminal Epidural Blood Patch

[Year:2016] [Month:May-August] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:56-58][No of Hits : 331]


ABSTRACT

Introduction: Injury to the dural membrane during spinal surgery may result in persistent cerebrospinal fluid (CSF) leak. Prompt management to stop this CSF leak is warranted to avoid serious neurological consequences. Many surgical and nonsurgical interventional techniques including epidural blood patch have been advocated. We present a case report where transforaminal epidural blood patch was used successfully to manage persistent CSF leak after laminectomy.

Keywords: Contralateral, CSF leak, Epidural blood patch, Laminectomy, Spinal headache, Transforaminal.

How to cite this article: Jadon A, Jain P. Postoperative Cerebrospinal Fluid Leak managed with Transforaminal Epidural Blood Patch. J Recent Adv Pain 2016;2(2):56-58.

Source of support: Nil

Conflict of interest: None


 
Editorial 2
Pravin Thomas

Changing Paradigms in Understanding Pain: The Role of Networks, Genomics and Proteomics

[Year:2015] [Month:May-August] [Volumn:1 ] [Number:1] [Pages:63] [Pages No:3-4][No of Hits : 449]


ABSTRACT

When we are posed with a clinical problem in pain medicine, as in most other branches of medicine, we follow a set of time-tested techniques. This involves understanding the anatomic substrate, which, in pain medicine is the ‘pain generator’. We further probe into the etiopathophysiology underlying the problem. This also leads us to understand the possible array of neurotransmitters and other chemicals involved in generation and propagation of pain. This is the current state of clinical pain medicine.


 
Letter-to-the Editor
Dilip Chandar, Neha Vyas

Evaluation of Transversus Abdominis Plane Block for Analgesia after Cesarean Section

[Year:2015] [Month:September-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:101][No of Hits : 366]


ABSTRACT

This letter is about the article ‘Evaluation of Transversus Abdominis Plane Block for Analgesia after Cesarean Section’ which was published in your journal in the recent edition.1 The study is a novel approach for postoperative analgesia following cesarean section which can be considered superior to conventional parenteral analgesics. Though the outcomes of the study will help in improving patient care in perioperative period; there are some lacunae in the study which are listed as below.


 
Letter-to-the Editor
Sonai Dutta Kakoti

Changing Paradigms in Understanding Pain: The Role of Networks, Genomics and Proteomics

[Year:2015] [Month:September-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:100][No of Hits : 281]


ABSTRACT

As we all know pain is a subjective phenomena and apart from its effect on our physiological systems of body, it affects our brain and hence our emotional components too. Hence, the treatment becomes multidimensional and at the same time sometimes difficult to treat. Multidisciplinary team approach becomes the need. We have evolved from a simple conventional pharmacotherapy to new drugs to interventional procedures, cognitive and behavioral therapy, psychological counseling and other modalities and so on. But still the question is; is it the end and have we really succeeded in eradicating chronic pain? What next and what more can be done?



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