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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]
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An unusual case of lumbar facet arthropathy presenting with pain abdomen
Palak Chavda, Gautam Das, Ravi S Sharma
September-December 2017, 3(3):142-144
Introduction: Facet joint arthropathy refers to a degenerative disease that affects the joints of the vertebrae. Lumbar facet joints (zygapophyseal joint) were first suggested in the medical literature as a source of low back pain (LBP) and lower extremity pain in 1911. These joints have been implicated as the cause of pain in 15 to 45% of patients with chronic LBP. The majority of published clinical investigations report no correlation between the clinical symptoms of LBP and degenerative spinal changes observed on radiologic imaging studies, including radiographs, magnetic resonance imaging (MRI), computed tomography (CT), single photon emission CT, and radionuclide bone scanning. Low back pain from the facet joints often radiates down into the buttocks and down the back of the upper leg. Pain is rarely present in the front of the leg or below the knee. Our case report is about a 24-year-old female patient who presented with left-sided paramedian LBP with severe lower abdominal pain, who underwent several investigations for her abdominal pain and was treated for abdominal pain without any significant relief. Careful history and clinical examination revealed lumbar facet joint tenderness involving left L4–L5 and L5–S1 facet joint. Diagnostic block followed by radiofrequency (RF) ablation of medial branch supplying the corresponding facet joint was performed with near-complete pain relief.
[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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Bipolar radiofrequency ablation of genicular nerves in patients with pacemaker
Ashok Jadon
May-August 2015, 1(2):97-99
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.
[ABSTRACT]   Full text not available  [PDF]
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Atypical presentation of cervical facet arthropathy: Neck pain along with numbness and weakness of upper limb
Deepika Soni, Gautam Das, Mousumi Datta
September-December 2016, 2(3):106-108
Most of the cervical facet arthropathy cases present with neck pain with referred pain in the head and upper extremities. Tenderness to palpation over the facet joints or paraspinal muscles, accentuation of pain with cervical extension or rotation, and the absence of any neurologic deficits are the usual findings. Radicular symptoms are seldom associated with cervical facet arthropathy. We report a case of a 23-year-old female patient presented with chief complaints of neck pain radiating to entire right upper limb with weakness and numbness of that limb. Physical examination revealed limitation of range of motion of neck, painful extension and lateral rotation of neck, tenderness over C4-5 and C5-6 facet joints, and tenderness over right trapezius muscle. Weakness and numbness over hand was also present, though electromyography and nerve conduction velocity study was normal in both upper limbs. Magnetic resonance imaging (MRI) cervical spine was suggestive of mild posterior disk osteophytes at C4-5, C5-6, and C6-7 causing grade 1 cervical canal stenosis and cervical spondylosis with degenerative disk disease. Trigger point injections were given in trapezius and scalene muscle. There was not much improvement. Considering facet arthropathy as a differential diagnosis, diagnostic median branch block at C4, C5, and C6 level was done. It was positive with more than 80% pain relief. Later on, radiofrequency (RF) ablation of C4, C5, and C6 median branch was done. Pain was reduced significantly with improvement of other symptoms like weakness and numbness.
[ABSTRACT]   Full text not available  [PDF]
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Median arcuate ligament syndrome: A rare cause of epigastric pain
Sachin Khanduri, Vivek K Yadav, Harsh Yadav, Ekta Tyagi, Sushma Pandey
September-December 2018, 4(3):112-114
Aim: To diagnose and aid the treatment of a patient with an unknown cause of epigastric pain. Background: Harjola first described median arcuate ligament syndrome (aka celiac artery compression syndrome) in 1963. Typically it occurs in young patients (20–40 years age group) and is more common in lean women, presents with epigastric pain and weight loss. Case description: An 18-year-old male visited the emergency room with a complaint of recurrent episodes of abdominal pain. There was no past or any medical history of any previous illness. On physical examination, the patient was afebrile and had pallor. All the vitals were within normal limits. The abdominal examination did not reveal any significant abnormality. Laboratory investigations (Hb, GBP, TLC) were within normal limits. Conclusion: Median arcuate ligament syndrome is a rare clinical entity which can be found in normal asymptomatic people. In a few cases, however, celiac axis compression can cause symptoms which can be relieved with laparoscopic surgical decompression. Clinical significance: The median arcuate ligament syndrome as an entity must be kept in mind when no other cause of abdominal pain is zeroed on even after all the clinical examinations and investigations.
[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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Chronic pain due to bilateral neuroma mimicking complex regional pain syndrome on an amputated finger stump: A case report
Sekar Michael, Sreeraman Geetha, Venugopal Sarveswaran, Veena Jeyaraj, Vasanth R Palanimuthu
January-April 2020, 6(1):41-43
A 62-year-old man presented with chronic pain with an exacerbation for the last 15 days. His left index finger was surgically amputated and the pain was around the base of his index finger which was referred to forearm and other fingers too. A couple of years ago, he sustained an injury to the left index finger and started having pain once the wound was healed. Subsequently exploration was done to relive pain which did not reduce and for some unknown reason the finger was amputated surgically later. Although the symptoms and signs were mimicking complex regional pain syndrome (CRPS), the other possible causes for the pain such as nerve entrapment and neuromas on the course of the nerve were considered. The surgical exploration was done at the stump and multiple neuromas were found. The neuromas were removed and the wound was closed by carefully burying the nerve endings. Patient had a complete pain relief at the second postoperative day and he had been followed for the next couple of weeks.
[ABSTRACT]   Full text not available  [PDF]
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Lumbar sympathectomy in an ankylosing spondylitis patient with vasculitis: A case report
Venu Narayanapanicker, Bhupider Pal Singh, Gautam Das
September-December 2019, 5(3):87-89
In ankylosing spondylitis (AS), the axial skeleton, peripheral joints, and extra-articular structures are also frequently involved. Cutaneous lesions and vasculitis is extremely rare. Lumbar sympathectomy has a definite role in patients with painful cutaneous vasculitis and ischemic leg ulcer, especially those refractory to medical management. Despite the relatively small percentage of patients suffering from chronic leg ulcer, it has a significant impact on the patient's quality of life. A 44-year-old male AS patient with low backache (LBA) of 15 years and bilateral leg pain came to us. But in the past 2 years, severity of pain worsened resulting in infection and ulcer of dorsum of both feet. Examination confirmed multiple ulcers along with sensory loss on the dorsum of foot bilaterally. Not only he was refractory to conventional medical management, but he also had developed various side effects. Our results of diagnostic left lumbar sympathetic block (LSB) turned out to be positive. Next day, radiofrequency ablation (RFA) of lumbar sympathetic chain bilaterally at L2, L3, and L5 was done, and the patient was discharged pain free. At the 3-month review, the leg ulcers had healed, and the patient was pain free. So here, we discuss about the possible mechanisms and the role of LSB in vasculitic leg ulcers.
[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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Anesthesia in awake craniotomy: Advantages of dexmedetomidine infusion over conventional methods
Sarika S Naik, Lokesh Kumar, Surjya K Mohanty, Sanjay Banakal, L Channakeshava
May-August 2016, 2(2):65-68
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.
[ABSTRACT]   Full text not available  [PDF]
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Platelet rich plasma, platelet lysate, freeze-dried platelets and next
R Gurumoorthi
May-August 2015, 1(2):65-66
Full text not available  [PDF] [CITATIONS]
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A prospective randomized and double-blind study to evaluate the efficacy of magnesium sulfate on postoperative analgesic requirement in patients undergoing laparoscopic cholecystectomy
Ashutosh Singh, Hariom Khandelwal, Anoop Negi, Bhaskar Dutta, Priyanka Rani
May-August 2016, 2(2):49-53
Background and aims: Magnesium sulfate has recently gained popularity as an adjuvant to general anesthesia. It acts as a blocker of N-methyl D-aspartate (NMDA) antagonist and hence may have a potential role in the prevention of postoperative pain. The aim of the present prospective, randomized, double-blind, and placebocontrolled study was to evaluate the efficacy of injection magnesium sulfate 50 mg/kg as premedication upon postoperative pain and analgesic requirement in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Materials and methods: After obtaining institutional ethical committee approval, 100 patients of American Society of Anesthesiologists (ASA) grade 1 and 2 undergoing laparoscopic cholecystectomy under general anesthesia were randomly allocated into two groups to receive either 50 mg/kg magnesium sulfate in normal saline to a total volume of 5 mL (group M, n = 50) or 5 mL of normal saline (group S, n = 50) as premedication prior to general anesthesia. The patients were continuously monitored for postoperative pain using visual analog scale (VAS) in the immediate postoperative period and subsequently at 2-hour intervals for the next 24 hours. Injection tramadol 1 mg/kg was given as the rescue analgesic (VAS ≥ 4). Results: Both the groups were comparable with respect to demographic variables. There was no statistically significant difference in the postoperative VAS scores (p = 0.489) and tramadol requirement among the groups (p = 0.38). Conclusion: Magnesium sulfate 50 mg/kg premedication is ineffective in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy under general anesthesia.
[ABSTRACT]   Full text not available  [PDF]
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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]
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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]
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Prolotherapy: From glorious past to promising future
Neelesh K Mathankar, Mayank Chansoria
January-April 2017, 3(1):41-45
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.
[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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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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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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Intra-articular injection of platelet-rich plasma in the management of chronic low back pain due to facet arthropathy: A case report with 12 months follow-up
Samarjit Dey, Prithwis Bhattacharyya, Priyanka Dev
January-April 2015, 1(1):26-27
Platelet-rich plasma prolotherapy (PRPP) helps to heal the injured tissue. Connective tissue repair is the platelet function that PRPP operates on. Platelet concentrations, when increased in a specific area, stimulate rapid healing. The main focus of PRPP is on the alpha granules, as these structures house all of the growth factors essential to PRPP in inactivated forms. Here, we report a case of lumbar facet arthropathy, which was successfully treated with intra-articular PRP injection. Patient was pain free after 12 months follow-up. We want to highlight that intra-articular PRP injection may be a future potential alternative therapy for facet arthropathy.
[ABSTRACT]   Full text not available  [PDF]
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The diagnostic dilemma of a genitofemoral-ilioinguinal overlap syndrome
Pravin Thomas, Gautam Das
January-April 2015, 1(1):28-30
Background: It is sometimes difficult to clinically delineate genitofemoral and ilioinguinal neuralgias because of the overlap in the clinical symptomatology. Case description: A young male with a past history of transurethral removal of ureteral calculi presented with severe, debilitating neuropathic pain in the groin. He had hyperpathia and allodynia in the distribution of genitofemoral nerve, and hence a clinical diagnosis of genitofemoral neuralgia was made. An ultrasound guided diagnostic block of the genitofemoral nerve with local anesthetic produced only a mild reduction in pain (VAS 2 reduction). A repeat diagnostic block of the ilioinguinal nerve produced complete resolution of pain. Literature search showed a limited number of case reports of ultrasound guided blocks for genitofemoral neuralgia; and overlap syndromes have been addressed with differential nerve blocks. Clinical relevance: Our hypothesis is that an aberrant reinnervation from the ilioinguinal to genitofemoral nerve may present with features favoring a genitofemoral neuralgia. In situations where radiofrequency treatment is being considered, such cases may pose a failed intervention if both nerves are not separately targeted.
[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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Superior cluneal nerve entrapment—Possible pain generator in low back pain
Uttam Sidhaye, Varshali M Keniya, Anutosh D Kulkarni
May-August 2019, 5(2):60-62
High number of patients coming to pain clinic complain of low back pain (LBP) and this puts the pain physician in lot of diagnostic predicament. Consideration of common reasons from myofascial pain generator to rarer like cluneal nerve entrapment requires updating of knowledge regarding various rare pain generators in the back region. The cutaneous branches of cluneal nerve, namely, superior and middle are purely sensory. They provide sensation in the lumbar region and the buttocks, and their impingement around the iliac crest can cause LBP radiating to lower limb. Diagnosing uncommon cause for LBP owing to superior cluneal nerve impingement becomes a challenging task due to the absence of any diagnostic criteria apart from the high-index suspicion based on clinical findings and ruling out other common causes of LBP. It is usually misdiagnosed as a lumbar spine disorder. Here we present a case of chronic low backache with vague symptoms, which was successfully treated with the cluneal nerve block and the diagnosis of cluneal nerve entrapment was confirmed.
[ABSTRACT]   Full text not available  [PDF]
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Burst compression fracture in ankylosing spondylitis: A challenging case of vertebroplasty
Snehil Gupta, Gautam Das, Amiya Mishra, Abhishek Gupta
September-December 2017, 3(3):147-150
Ankylosing spondylitis (AS) is a chronic inflammatory joint disease. Osteoporosis and fractures of the vertebral body and its dorsal arch are now well-recognized features because of the altered biomechanics of the ankylosed spine. “Seat belt ” or “burst compression” fractures through the disk, juxta-end plate, and posterior segments have been observed very often in the thoracolumbar spine. These are associated with increasing pain with or without neurologic deficit, and may require intervention. Vertebroplasty has proven benefits in the treatment of stable spinal fractures and this technique allows complete or marked pain relief and bone strengthening in most cases. Decision to perform vertebroplasty should be made by a multidisciplinary team. In this case report, we have tried to emphasize on the fragility of the spine that can result from minor injury as well as the management of thoracic vertebral fracture complicating AS.
[ABSTRACT]   Full text not available  [PDF]
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