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JAYPEE JOURNALS
International Scientific Journals from Jaypee
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1.  ORIGINAL ARTICLE
Rami Communicans Block Prior to Transforaminal Endoscopic Discectomy relieves Procedure Pain Significantly and adds Safety: A Case–control Study
Gautam Das, Samarjit Dey, Ravi S Sharma, Kanchan Sharma, Debjyoti Dutta, Chinmoy Roy
[Year:2017] [Month:May-August] [Volume:3 ] [Number:2] [Pages:51] [Pages No:90-95] [No of Hits : 972]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10046-0076 | FREE

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

 
2.  ORIGINAL ARTICLE
Multimodal Cocktail Injection relieves Postoperative Pain and improves Early Rehabilitation following Total Knee Replacement: A Prospective, Blinded and Randomized Study
Vikram I Shah, Sachin Upadhyay, Kalpesh Shah, Ashish N Sheth, Amish Kshatriya, Deepak Saini
[Year:2017] [Month:January-April] [Volume:3 ] [Number:1] [Pages:57] [Pages No:14-24] [No of Hits : 664]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10046-0060 | FREE

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

 
3.  EDITORIAL
Inevitable Evolution: How Technology has transformed Physician–Patient Partnership?
Annu Navani
[Year:2017] [Month:January-April] [Volume:3 ] [Number:1] [Pages:57] [Pages No:1-2] [No of Hits : 651]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10046-0057 | FREE

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

 
4.  CASE REPORT
Coccydynia with Central Sensitization plays an Important Role as Pain Generator
Sunny Malik, Gautam Das, Monika Dabgotra, Mousumi Datta
[Year:2016] [Month:May-August] [Volume:2 ] [Number:2] [Pages:31] [Pages No:62-64] [No of Hits : 1750]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10046-0043 | FREE

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

 
5.  CASE REPORT
Interspinous Ligament as a Pain Generator
Rammurthy Kulkarni, RM Ramyashree
[Year:2016] [Month:May-August] [Volume:2 ] [Number:2] [Pages:31] [Pages No:54-55] [No of Hits : 773]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10046-0040 | FREE

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

 
6.  PRACTITIONER’S SECTION
S1 Transforaminal: Technique and Troubleshooting
Pankaj Surange
[Year:2016] [Month:January-April] [Volume:2 ] [Number:1] [Pages:36] [Pages No:15-17] [No of Hits : 737]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10046-0028 | FREE

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

 
7.  ORIGINAL ARTICLE
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
Mayank Chansoria, Sachin Upadhyay, Sheetal Panwar, Piyush Shivhare, Neha Vyas
[Year:2016] [Month:January-April] [Volume:2 ] [Number:1] [Pages:36] [Pages No:11-14] [No of Hits : 725]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10046-0027 | FREE

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

 
8.  REVIEW ARTICLE
Ultrasound-guided Stellate Ganglion Block
Rammurthy Kulkarni
[Year:2016] [Month:January-April] [Volume:2 ] [Number:1] [Pages:36] [Pages No:22-24] [No of Hits : 661]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10046-0030 | FREE

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

 
9.  CASE REPORT
Single Level Thoracic Paravertebral Block for Analgesia in Modified Radical Mastectomy in a Comorbid Female
Raghvendra Upadhyay, Mayank Chansoria, Ravindra Harne, Ruchi Singh
[Year:2016] [Month:January-April] [Volume:2 ] [Number:1] [Pages:36] [Pages No:25-27] [No of Hits : 581]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10046-0031 | FREE

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

 
10.  CASE REPORT
Anesthesia in Awake Craniotomy: Advantages of Dexmedetomidine Infusion over Conventional Methods
Sarika S Naik, Lokesh Kumar, Surjya K Mohanty, Sanjay Banakal, L Channakeshava
[Year:2016] [Month:May-August] [Volume:2 ] [Number:2] [Pages:31] [Pages No:65-68] [No of Hits : 536]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10046-0044 | FREE

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

 
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