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.

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 mg/kg clonidine, and group 3 (n = 40) received 30 ml of 0.5% ropivacaine with 1 mg/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.

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.

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.

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.

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.

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.

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.