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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.