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JAYPEE JOURNALS
International Scientific Journals from Jaypee
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1.  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 : 1811]
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

 
2.  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 : 1105]
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

 
3.  ORIGINAL ARTICLE
Neck Pain in a Young Girl: A Pott’s Disease Case Study
Nuruzzaman Khandaker, Syed M Ahmed, Israt Hasan, Amitav Banik
[Year:2017] [Month:May-August] [Volume:3 ] [Number:2] [Pages:51] [Pages No:81-84] [No of Hits : 727]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10046-0074 | FREE

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

 
4.  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 : 708]
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

 
5.  CASE REPORT
Serratus Anterior Plane Block failed to relieve Pain in Multiple Fractured Ribs: Report of Two Cases
Ashok Jadon, Priyanka Jain, Mayur Motaka
[Year:2017] [Month:January-April] [Volume:3 ] [Number:1] [Pages:57] [Pages No:50-53] [No of Hits : 596]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10046-0066 | FREE

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

 
6.  ORIGINAL ARTICLE
Effect of Music Therapy on Labor Pain among Women in Active Labor admitted in Tertiary Care Hospital, Kochi City
Tintu Xavier, Lekha Viswanath
[Year:2017] [Month:January-April] [Volume:3 ] [Number:1] [Pages:57] [Pages No:3-6] [No of Hits : 543]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10046-0058 | FREE

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

 
7.  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 : 2054]
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

 
8.  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 : 1468]
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

 
9.  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 : 1433]
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

 
10.  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 : 1092]
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

 
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