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Hip prolotherapy
Alif N Rahman, Hanindya Prasojo
January-April 2020, 6(1):36-38
Background: Chronic musculoskeletal disease is one of the causes of a patient seeking help from a doctor due to the inhibition of daily activity, and hip pain is one of them.[1] Not everyone who is a candidate for an operation will choose this option.[1],[2] Prolotherapy is becoming a widespread form of pain management associated with chronic tendonitis and joint degenerative arthritis. Prolotherapy then becomes an affordable cost treatment option and can be a consideration for patients who are contraindicated for surgery.[4],[5] Case description: A 63-year-old female arrived complaining of right hip pain for 10 months. She began feeling the pain after motorcycle collision with the right hip crashing into the street. The pain would come and go but had been especially troubling after 2 months of accident. She noticed decreased strength and inability to abduct her right hip. The problem progressed until she could not walk without pain. The patient underwent four dextrose prolotherapy treatments at 3-week intervals. Conclusion: Prolotherapy may be an additional method and even a solution with a good prognosis for the treatment of hip chronic musculoskeletal pain. The dramatic loss of pain for the patient after a series of prolotherapy injection, and radiological parameters showed improvement, is the reason why hip prolotherapy is considered indispensable for people suffering with chronic hip pain.[1],[2],[3]
[ABSTRACT]   Full text not available  [PDF]
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Effect of music therapy on labor pain among women in active labor admitted in tertiary care hospital, Kochi City
Tintu Xavier, Lekha Viswanath
January-April 2017, 3(1):3-6
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.
[ABSTRACT]   Full text not available  [PDF]
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A comparative study of dexmedetomidine and fentanyl as adjuvants with bupivacaine in adductor canal block regional anesthesia in total knee replacement surgery
Sarika S Naik, Channabasava Patil, Chaitra Venkategowda, Narasimha Reddy
January-April 2020, 6(1):4-9
Background/objectives: Total knee replacement surgeries being the ultimate operative modality are commonly performed for severe osteoarthritis. The challenges for the anesthesiologists are to provide optimal postoperative analgesia with minimum motor blockade, so that the patients can be ambulated early, thereby minimizing the complications of delayed ambulation. Materials and methods: We compared the efficacy of fentanyl and dexmedetomidine in improving the analgesic efficacy of bupivacaine-driven regional anesthesia adductor canal block (ACB) in 60 patients who underwent total knee replacement surgeries. We conducted a randomized study of two different drug formulations for the same procedure with random allocation using a computerized table. Results: The visual analog scale (VAS) score of the patients was less in group D. The number of steps walked and the time taken to stand from supine position was better in group D. The amount of local anesthetic requirement was less in group D. Nonsteroidal anti-inflammatory drug (NSAID) requirement was comparable in both the groups. Conclusion: In our study, we observed that VAS score is less in group D, thereby promoting early ambulation and better patient satisfaction. Hence, dexmedetomidine is a better adjuvant than fentanyl for regional anesthesia.
[ABSTRACT]   Full text not available  [PDF]
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Neck pain in a young girl: A pott's disease case study
Nuruzzaman Khandaker, Syed M Ahmed, Israt Hasan, Amitav Banik
May-August 2017, 3(2):81-84
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.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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Comparison of effect of intrathecal buprenorphine vs clonidine as an adjuvant to hyperbaric bupivacaine on subarachnoid block characteristics
Anoop Singh Negi, Mayank Gupta, Ashutosh Singh
May-August 2015, 1(2):67-72
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.
[ABSTRACT]   Full text not available  [PDF]
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Ganglion impar block and neurolysis for chronic pain: A review
Mayank Gupta, Gautam Das
January-April 2020, 6(1):24-28
Aim: This article aims to review the currently available evidence on the ganglion impar block (GIB) and neurolysis for management of chronic pain of malignant or nonmalignant etiology. Introduction: Ganglion impar (GI) represents the fused termination of bilateral thoracolumbar sympathetic chains. It is a retroperitoneal structure, lying behind the rectum and ventral to the sacrococcygeal junction (SCJ) or coccyx. Ganglion impar provides sympathetic and nociceptive innervation to the perineum, coccyx, anus and distal urethra, rectum, vagina, and vulva. In this review, the indications, approaches, effectiveness and, complications of GIB are discussed based on the data from the current literature. Results: We screened 18 full-text studies based on our search. Out of them, 2 were randomized controlled trials (1 each on GIB for chronic intractable coccydynia and phantom rectum pain), 15 were observational (prospective or retrospective) studies, and 1 was anatomic cadaveric study. These studies included were from 2004 to till date. Our review results inferred that (1) GIB appears to be a safe and effective technique for management of pain in patients with chronic coccydynia, chronic perineal and pelvic pain, not responding to the conservative measures; (2) both anatomic location of GI and technical feasibility favor the transcoccygeal approach (Co1–Co2) as the most suitable approach followed by the transsacrococcygeal approach. Conclusion: Ganglion impar block improves pain and the quality of life in patients suffering from chronic intractable coccydynia, chronic perineal and pelvic pain of both malignant and nonmalignant etiology.
[ABSTRACT]   Full text not available  [PDF]
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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
January-April 2017, 3(1):14-24
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.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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Low back pain in a young adult: A case of bertolotti syndrome
Kashinath Bangar, Nivedita Page, Varsha S Kurhade
September-December 2018, 4(3):110-111
Aim: The aim of this report is to stress upon Bertolotti syndrome being a common cause of back pain in young adults and possible futility of interventional pain management in such cases. Background: Bertolotti's syndrome is characterized by unilateral or bilateral enlargement of the transverse process of the most caudal lumbar vertebra which may articulate or fuse with the sacrum or ilium. The syndrome affects 4 to 21% some reports stating incidence to be as high as 30% of the population. Diagnosis is not difficult if clinical suspicion is high, but mimics other common causes of low back pain. Treatment by interventional pain management may not be very effective as the problem is structural. Case report: A 32-year-old soldier with low back pain, not relieved with medication was diagnosed with right-sided sacroiliitis. X-ray showed fusion of the transverse process of the 5th lumbar vertebra with the iliac crest. A fluoroscopy-guided sacroiliac joint injection along with the injection of the pseudoarthrosis was performed with no relief. An MRI scan was done which revealed degenerative disc at L4-L5 level. Caudal epidural steroid injection was done, however, the patient failed to obtain relief. He was then referred to a spine surgeon who has advised him surgery. Conclusion: We conclude that Bertolotti's syndrome could be an important cause of intractable back pain in young adults. Being a structural anomaly, usually, surgical intervention is needed. Clinical implication: Patients with Bertolloti syndrome should be taken up for interventional pain management, after explaining guarded prognosis due to it being a structural anomaly.
[ABSTRACT]   Full text not available  [PDF]
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Chest pain…? Not always the heart…!
Bijay Mallikarjun, Gautam Das, Abhisesh Shrestha
January-April 2019, 5(1):22-23
It has become problematic that the number of noncardiac chest pain (NCCP) patients is increasing among those who come to the emergency room with chest pain as a chief complaint. They tend to come to hospitals often and over many years, even after cardiac chest pain has been excluded from their diagnosis. Moreover, studies have shown that NCCP patients have a high prevalence of anxiety, depression, and disability. However, most NCCP patients are usually treated by cardiologists or primary physicians. Ordinary biomedical approaches often fail to treat NCCP. NCCP is one of the most important functional somatic syndromes from the view of medical economics. The cause of NCCP includes gastroesophageal reflux disease (most common), panic disorder, and esophageal dysmotility.
[ABSTRACT]   Full text not available  [PDF]
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Evidence-based medicine: Two sides of the same coin
Praneet Singh, Gautam Das, Amit Sequeira
September-December 2018, 4(3):89-90
Any discussion about evidence-based medicine (EBM) is bound to reveal both negative and positive reactions. Evidence-based practice with respect to interventional pain management specialty is reviewed here, and the most common appraisals and criticisms described. A few potential solutions to the most common negative reactions are being described with a highlight on future areas anticipating further input of efforts.
[ABSTRACT]   Full text not available  [PDF]
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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
M Vijay Anand, Vanathi Nachimuthu, Gurumoorthi Ramasamy
January-April 2018, 4(1):6-9
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: T his method i s a very e ffective and cheap anesthesia modality in daycare perineal surgery.
[ABSTRACT]   Full text not available  [PDF]
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Evaluation of transversus abdominis plane block for analgesia after cesarean section
Mayank Chansoria, Sevras Hingwe, Ashish Sethi, Ruchi Singh
January-April 2015, 1(1):13-17
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.
[ABSTRACT]   Full text not available  [PDF]
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Lipoma arborescens in bicipitoradial bursae: A rare anterior painful elbow swelling with dual morphology
Mohammad Moin Uddin, Md Abu Bakar Siddiq, Aminuddin A Khan
January-April 2015, 1(1):33-35
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.
[ABSTRACT]   Full text not available  [PDF]
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Coccydynia with central sensitization plays an important role as pain generator
Sunny Malik, Gautam Das, Monika Dabgotra, Mousumi Datta
May-August 2016, 2(2):62-64
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.”
[ABSTRACT]   Full text not available  [PDF]
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Interspinous ligament as a pain generator
Rammurthy Kulkarni, RM Ramyashree
May-August 2016, 2(2):54-55
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.
[ABSTRACT]   Full text not available  [PDF]
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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
May-August 2017, 3(2):90-95
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 II (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.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  113 0 1
Combined nasociliary and infraorbital nerve block: An effective regional anesthesia technique in managing nasal bone fracture
Sarika S Naik, Sudhir M Naik
January-April 2019, 5(1):3-5
Background: Closed reduction of the fractured and displaced nasal bones results in nasal bleeding at the site of fracture which needs judicious management. Usually general anesthesia is used with orotracheal intubation, whereas managing these cases with combined nasociliary and infraorbital blocks needs a better understanding of the surface landmark and foraminal anatomy. Materials and methods: We report a randomized study of 2 groups of 25 patients each, with fractures of the nasal bones in our institution over 12 months. Group I included 25 patients with nasal bone fracture reduction done under general anesthesia, and group II included 25 patients in whom regional block anesthesia was given. Most of the patients in the study were in the ASA grade I and II and all had obvious nasal deformity observed and recorded with a history of trauma and injury. Results: The time for full sensory loss in group A was 45 minutes and 21 minutes in group B. The procedure time of 12 minutes was the same in both the groups, while an added imaging time of 15 minutes resulted in an overall procedure time of 27 minutes. Splints were used for septal support as well as externally, which needed an extra 20 minutes for the gypsum salt or the thermoplast to settle. The time of recovery was immediate in group B, while 20 minutes of recovery was seen in group A. Most of the patients in group A commented a painless recovery, while most patients of group B commented an experience of discomfort during the procedure. Conclusion: Unilateral fractures were reduced under regional block anesthesia. Comorbidities should overweigh compliance while preferring regional anesthesia, as the risks involved in general anesthesia have been reduced to the minimum possible extent. The regional block has reduced the operative costs but the complications of the procedure are nearly equal in both types of anesthesia.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  113 0 1
Platelet-rich plasma for shoulder joint
Khaja J Khan, Gautam Das, Jeshnu P Tople, Shirish P Amatya, Sabir Pottichi
January-April 2019, 5(1):16-19
Introduction: Shoulder pain is a common and disabling complaint. The reported annual incidence of shoulder pain in primary care is 14.7 per 1000 patients per year with a lifetime prevalence of up to 70%. The most common causes of shoulder pain are rotator cuff tendinopathy, frozen shoulder or adhesive capsulitis and acromioclavicular (AC) joint osteoarthritis. Glenohumeral joint arthritis is uncommon. Discussion: Platelet rich plasma (PRP) is plasma that contains higher than physiologic platelet content. It has been seen that these growth factors are markedly up-regulated following tendon injury and are active at multiple stages of the healing process. Platelet rich plasma is an autologous source of growth factors and has been found to be helpful for treatment of tendinopathies and osteoarthritis. Platelet rich plasma injections for shoulder joint pathologies can be done using either fluoroscopy or by ultrasound guidance. Conclusion: Fluoroscopic guided PRP injection is better than ultrasound guidance as it helps to inject PRP with a single needle prick at three sites including glenohumoral joint, supraspinatous tendon and acromioclavicular joint.
[ABSTRACT]   Full text not available  [PDF]
  113 0 -
Prevalence of pain in medical representatives using two-wheeler for daily commute
Vivek S Chawathe, Amit S Mhambre, Anil K Gaur, Vivek J Pusnake, Rajendra Sharma, Nima I Wangdi
May-August 2017, 3(2):61-65
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 "two-wheeler 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. Thepain 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 representativestraveling 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.
[ABSTRACT]   Full text not available  [PDF]
  112 0 -
Pain in multiple sclerosis: A South Indian experience
Pravin Thomas, Suresh Kumar, Anand Kumar
January-April 2015, 1(1):8-12
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.
[ABSTRACT]   Full text not available  [PDF]
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Case report of fibromyalgia
Uttam Sidhye, Parag Munot
May-August 2019, 5(2):70-72
Fibromyalgia is a common chronic syndrome defined by core symptoms of widespread musculoskeletal pain and stiffness throughout the connective tissues that support and move the bones and joints. Other common symptoms include cognitive difficulty, headache, paresthesia, morning stiffness, fatigue, and sleep disturbance. Fibromyalgia is increasingly understood as one of the several disorders that are referred to as central sensitivity syndromes. Tender points are often detected in patients with fibromyalgia. We report a case of 43-year-old female who presented with painful nodule over the palm and later developed generalized pain. Combination therapies with pregabalin, nortriptyline, and ketamine infusion relieved her symptoms over time. The management of fibromyalgia requires a multidimensional approach including patient education, cognitive behavioral therapy, exercise, and pharmacologic therapy. We present a case of fibromyalgia, which was initially treated with a combination of above modalities with partial benefit but actually benefited via ketamine infusion.
[ABSTRACT]   Full text not available  [PDF]
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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
Dileep Gupta, Vandana Mangal, Gaurav Sharma, Amit Kulshestha, Poonam Kalra
May-August 2017, 3(2):85-89
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.
[ABSTRACT]   Full text not available  [PDF]
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Neuropathic pain and depression: A prospective study to find out any association
Kanchan Sharma, Gautam Das, Samarjit Dey, Emmanuell Q Villano, Sripurna Mandal
January-April 2016, 2(1):6-10
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.
[ABSTRACT]   Full text not available  [PDF]
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Frozen shoulder: A brief review
Sayan Manna, Archana Y Nankar
January-April 2020, 6(1):29-32
Frozen shoulder, also known as adhesive capsulitis of the shoulder joint, is a very common and well-known entity in the field of pain medicine. The shoulder joint, being one of the most important and complex joint in the human body, gives much flexibility while compromising stability. But when flexibility is reduced, it causes much trouble and discomfort. Frozen shoulder is known for years but its definition, pathology, and treatment are yet to be standardized. In this article, there will be recapitulation of the anatomy, pathogenesis of frozen shoulder, and its correlation with clinical features in different stages, plus diagnosis of adhesive capsulitis on clinical examination as well as using advanced imaging techniques, will be discussed. The current available treatment modalities for frozen shoulder are also enumerated. Although newer imaging studies like arthrography, magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and ultrasound aid the diagnosis of frozen shoulder, clinical examination with exclusion of other pathology remains the mainstay and the most cost-effective way of diagnosis. The commonest treatment modality still being physiotherapy with some interventions; operative management is done only in very selected cases as the last option. Interventions like hydrodilatation of joint capsule and intraarticular platelet-rich plasma (PRP) have a very good role in management along with physiotherapy. It is recommended that ultrasound should be used routinely for the interventions in frozen shoulder.
[ABSTRACT]   Full text not available  [PDF]
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Postoperative cerebrospinal fluid leak managed with transforaminal epidural blood patch
Ashok Jadon, Priyanka Jain
May-August 2016, 2(2):56-58
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.
[ABSTRACT]   Full text not available  [PDF]
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