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ORIGNAL ARTICLES
Effect of addition of dexamethasone to ropivacaine in supraclavicular brachial plexus block
Feroz Ahmad Dar, Mohd Rafiq Najar, Neelofar Jan
September-December 2013, 27(3):165-169
DOI:10.4103/0970-5333.124602  
Background and Objectives: We evaluated the effect of adding dexamethasone to ropivacaine for supraclavicular brachial blockade. The primary endpoints were the onset and total duration of sensory and motor block, quality of analgesia, and duration of analgesia. Materials and Methods: Eighty patients of age group 20-50 years, scheduled for various elective orthopedic surgeries on forearm and around the elbow under supraclavicular brachial block were divided into two equal groups in a randomized, double-blinded fashion. In group R (n = 40), 30 ml (150 mg) of 0.5% ropivacaine + 2 ml saline; and in group RD (n = 40), 30 ml (150 mg) of 0.5% ropivacaine + 2 ml dexamethasone (8 mg) were given. Motor and sensory block onset times, block durations, quality of intraoperative analgesia, and duration of analgesia were recorded. Results: Demographic data and surgical characteristics were similar in both groups. The sensory and motor block onset time was earlier in group RD as compared to group R (P < 0.05). Sensory and motor blockade durations were longer in group RD than in group R (P < 0.001). Duration of analgesia was longer in group RD than in group R (P < 0.001). The 24 h Visual Analogue Scale (VAS) was more in group R as compared to group RD. The quality of anesthesia was excellent in both the groups. Mean arterial blood pressure levels in groups at 5, 10, 15, 30, 45, 60, 90, 120, and 150 min were statistically insignificant between the two groups (P > 0.05). The mean pulse rate at different time intervals was statistically insignificant between the groups (P > 0.05). Conclusions: Dexamethasone added to ropivacaine for supraclavicular brachial plexus block prolongs the duration of the block and the duration of postoperative analgesia.
  7 4,069 475
REVIEW ARTICLES
Challenges in pain assessment: Pain intensity scales
Praveen Kumar, Laxmi Tripathi
May-August 2014, 28(2):61-70
DOI:10.4103/0970-5333.132841  
Pain assessment remains a challenge to medical professionals and received much attention over the past decade. Effective management of pain remains an important indicator of the quality of care provided to patients. Pain scales are useful for clinically assessing how intensely patients are feeling pain and for monitoring the effectiveness of treatments at different points in time. A number of questionnaires have been developed to assess chronic pain. They are mainly used as research tools to assess the effect of a treatment in a clinical trial but may be used in specialist pain clinics. This review comprises the basic information of pain intensity scales and questionnaires. Various pain assessment tools are summarized. Pain assessment and management protocols are also highlighted.
  6 16,045 1,560
Neurolytic celiac plexus block for pancreatic cancer pain: A review of literature
Sankalp Sehgal, Ahmed Ghaleb
September-December 2013, 27(3):121-131
DOI:10.4103/0970-5333.124584  
The effective management of pancreatic cancer pain continues to be a major challenge for patients and clinicians. Up to 80% of patients with advanced pancreatic cancer present with the symptoms of severe pain. One of the most important goals in their management is achieving the highest quality of life throughout the course of disease with effective palliation of pain. Majority of the current data supports the use Neurolytic celiac plexus block (NCPB) and has been shown to be more effective in reducing pain compared with standard pharmacotherapy. NCPBs have led to decreased opioid requirements and related side effects, thus preventing deterioration in quality of life. In this article, we discuss the treatment of pancreatic cancer pain and the advances in techniques of performing NCPB. We also analyzed the incidence of complications and the quality of pain relief with the use of NCPB. NCPB is effective, has a low incidence of complications, and should be used more often in patients with pancreatic cancer pain.
  5 7,727 939
CASE REPORTS
Percutaneous radio frequency ablation for relief of pain in a patient of hip joint avascular necrosis
Prasad Kasliwal, Vidya Iyer, Sapana Kasliwal
May-August 2014, 28(2):121-123
DOI:10.4103/0970-5333.132855  
Avascular osteonecrosis (AVN) of the femoral head is one of the most common skeletal complications of kidney transplantation. Patients with hip joint avascular necrosis usually undergo joint arthroplasty. However, if a patient is unfit for surgery due to some comorbidities, hip joint articular branches denervation can be done to control pain and improve functional life. There is a large variation in the contribution as well in the position of the articular branches to hip joint by obturator, femoral, and sciatic nerves. Several authors have proposed percutaneous radio frequency denervation of the hip joint to eliminate pain.In our case, the patient was having an intractable hip joint pain which was not responding to conservative drug therapy as well physiotherapy. In our patient, hip arthroplasty was contraindicated because of the high risk of infection and anticoagulants. After diagnostic block, the pain in his groin and hip disappeared immediately. The patient noted a decrease in pain (Visual Analog Scale, VAS 9-10 to 1-2) and an improvement in the ability to walk. Then we performed percutaneous radio frequency ablation of the articular branches of the obturator nerve and the femoral nerve. Nerve blocks were performed via a combined approach using fluoroscopy and nerve stimulation to identify the obturator nerve. Because optimal coagulation requires electrodes to lie parallel to the nerves, a perpendicular approach probably produced only a minimal lesion. A perpendicular approach is likely to puncture femoral vessels. Vessel puncture can be avoided if an oblique pass is used. The patient had improved ability to ambulate and the patient can carry out his daily routine activites at home without much pain and can sleep comfortably. There were no complications like motor deficit, neuritis, bleeding, or infection. Our case report gives few impressions. First, it shows that if radio contrast agent (omnipaque dye) use is restricted or contraindicated, a combined approach using fluoroscopy and nerve stimulation to identify the obturator nerve and articular branch of femoral nerve. Second, it confirms the radiological anatomy of articular branches of hip joint. Third, oblique approach is safe and gives optimum lesion.
  4 3,824 384
ORIGNAL ARTICLES
Ameliorative effect of ethyl pyruvate in neuropathic pain induced by chronic constriction injury of sciatic nerve
Varsha J. Bansode, Neeraj S. Vyawahare, Neeraj B. Munjal, Pradip N. Gore, Pushpendra S. Amrutkar, Snehashree R. Sontakke
May-August 2014, 28(2):82-88
DOI:10.4103/0970-5333.132845  
Objective: The present study was designed to investigate the ameliorative effects of ethyl pyruvate (EP) in chronic constriction injury (CCI)-induced painful neuropathy in rats. Materials and Methods: EP 50 and 100 mg/kg was administered for 21 consecutive days starting from the day of surgery. The effects of EP in the paw pressure, acetone drop, and tail heat immersion tests were assessed, reflecting the degree of mechanical hyperalgesia, cold allodynia, and spinal thermal sensation, respectively. Axonal degeneration of the sciatic nerve was assessed histopathologically. The levels of thiobarbituric acid reactive species, reduced glutathione (GSH), catalase (CAT), and superoxide dismutase (SOD) were determined to assess oxidative stress. Key Findings: Administration of 50 and 100 mg/kg EP attenuated the reduction of nociceptive threshold in the paw pressure, acetone drop, and tail heat immersion tests. EP 100 mg/kg significantly attenuated reactive changes in histopathology and increase in oxidative stress. Conclusion: EP 100 mg/kg showed beneficial activity against nerve trauma-induced neuropathy. Hence, it can be used as a better treatment option in neuropathic pain (NP). The observed antinociceptive effects of EP may possibly be attributed to its antioxidant and anti-inflammatory activity.
  4 5,163 304
Prospective, randomised, double blinded controlled trial of gabapentin and pregabalin as pre emptive analgesia in patients undergoing lower abdominal and limb surgery under spinal anaesthesia
Induja Rajendran, Asha Basavareddy, Bikash Ranjan Meher, Srikanth Srinivasan
September-December 2014, 28(3):155-159
DOI:10.4103/0970-5333.138450  
Introduction: Postoperative pain management of high quality is important and in majority of post surgical cases pain is not treated adequately. We have evaluated the efficacy and safety of pregabalin and gabapentine as preemptive analgesic for post operative pain management in patients undergoing lower abdominal and lower limb surgery under spinal anesthesia. Materials and Methods: In a randomized double blind study, 90 patients were divided into three groups. Group G received tab gabapentin 900 mg, Group P received tab pregabalin 300 mg and Group C received placebo tablet orally 1 hour prior to surgery. All patients underwent surgery under spinal anesthesia using 0.5% Bupivacaine. Assessment of postoperative pain was made with visual Analogue Scale (VAS) score at 1, 2, 4, 6, 8, 12, 18, and 24 hours post operatively. Injection tramadol 100 mg was given as rescue analgesic intramuscularly when VAS score was > 7 in all the groups. Time to first rescue analgesics and number of rescue analgesics received were noted in all groups. The occurrences of side effects were noted in all groups. Results: The tramadol as rescue analgesia consumption was less in pregabalin and gabapentin groups compared to control and was statistically significant (P < 0.001). Initial VAS scores were lower in pregabalin (3.2 ± 0.4) and gabapentin (3.63 ± 0.32) groups compared to control (6.60 ± 0.77) and was statistically significant (P < 0.001). Time to first rescue analgesia was significantly longer for pregabalin (24.6 hours) followed by gabapentin (20.76 hours) and control (4.93 hours) groups. Conclusion: Pregabalin 300 mg single dose given 1 hour prior to surgery is superior to 900 mg gabapentin and placebo in attenuating post operative in patients undergoing lower abdominal and lower limb surgery. Both drugs are better than placebo.
  4 2,630 428
REVIEW ARTICLES
Comparative efficacy, safety, and tolerability of diclofenac and aceclofenac in musculoskeletal pain management: A systematic review
Faizal Vohra, Asawari Raut
January-April 2016, 30(1):3-6
DOI:10.4103/0970-5333.173431  
Diclofenac and aceclofenac are nonsteroidal antiinflammatory drugs (NSAIDs). Diclofenac is advocated for the treatment of painful and inflammatory rheumatic and certain nonrheumatic conditions such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, tendinitis, and bursitis, and in other inflammatory or painful conditions such as strains and sprains, dysmenorrhea, back pain, sciatica, and postoperative pain. Aceclofenac provides symptomatic relief in a variety of painful conditions such as joint inflammation, and reduces pain intensity and the duration of morning stiffness in the patients with rheumatoid arthritis, improves spinal mobility in the patients with ankylosing spondylitis. Gastrointestinal (GI) problems are the most frequent effects, which are caused by diclofenac and include dyspepsia and abdominal pain. Aceclofenac also has similar adverse effect but they are mild compared to diclofenac. We have reviewed 9 prospective studies that compared efficacy and safety of diclofenac with those of aceclofenac, 5 studies on osteoarthritis patients, 1 study on rheumatoid arthritis patients, 1 study on overall musculoskeletal disorders, 1 study on lower back pain, and 1 study on postextraction dental pain. Western Ontario and McMaster (WOMAC) universities scores, visual analogue scale (VAS), the Ritchie index, Lequesne OA severity index (OSI) were used in assessing the pain intensity and measuring the efficacy of the drug that proved beneficial in assessing the pain intensity and measuring the efficacy of both the drugs. All the studies came to the conclusion that aceclofenac is a better choice of drug in managing pain in case of all the above conditions with better efficacy and tolerability, patients experienced more number of adverse events (AEs) with diclofenac when compared with aceclofenac.
  4 60,507 1,668
Congenital insensitivity to pain: Review with dental implications
A Vijay Kumar, HP Jaishankar, Purnachandrarao Naik
January-April 2014, 28(1):13-17
DOI:10.4103/0970-5333.128880  
Pain causes a reflex withdrawal from any stimuli that can cause actual or potential tissue damage. It is frequently an early symptom of a disease process and is often the impetus for a patient to seek medical treatment. In many disorders where pain appears late, patients are at risk of developing complications without getting noticed. 'Congenital insensitivity to pain' is a rare disorder. Traumatic injury and self-mutilation is an almost consistent feature in this disorder. Injuries most frequently involve the oral and paraoral structures such as teeth, lips, tongue, and also ears, eyes, nose, and fingers. Oral manifestations may be the presenting complaint. Thus, it is important for the clinicians to be familiar with the condition. The present article provides a brief review of the condition and its insinuation in dentistry.
  4 3,113 322
Post-herpetic neuralgia: A review of current management strategies
Saru Singh, Ruchi Gupta, Sukhdeep Kaur, Jasleen Kaur
January-April 2013, 27(1):12-21
DOI:10.4103/0970-5333.114857  
Post herpetic neuralgia (PHN) is a chronic neuropathic pain in the region of the herpes zoster (HZ) rash, persisting after the cutaneous lesions have healed. Despite numerous treatment advances, many patients remain refractory to the current therapies and continue to have pain, physical and psychological distress. In this review, we will discuss the current strategies for prevention and management of this disease, as also the insight into the future probabilities.
  4 20,787 2,184
ORIGNAL ARTICLES
A comparison of analgesic effect of different doses of intrathecal nalbuphine hydrochloride with bupivacaine and bupivacaine alone for lower abdominal and orthopedic surgeries
B Jyothi, Shruthi Gowda, Safiya I Shaikh
January-April 2014, 28(1):18-23
DOI:10.4103/0970-5333.128881  
Background: Nalbuphine is a synthetic opioid with mixed agonist-antagonist action, when added as adjuvant to intrathecal bupivacaine acts on kappa receptors in the dorsal horn of the spinal cord producing analgesia. Aim: To evaluate the onset of sensory block, hemodynamic changes, duration and quality of analgesia, and adverse effects of different doses of nalbuphine with bupivacaine for spinal anesthesia. Materials and Methods: Randomized double blind study done on 100 patients undergoing lower abdominal and lower limb orthopedic surgeries under subarachnoid block. Patients were randomly allocated to four groups receiving either intrathecal 15 mg of bupivacaine + 0.5 mL normal saline alone or 15 mg of bupivacaine with either of nalbuphine 0.8, 1.6, and 2.5 mg + 0.5 mL normal saline. Results: The mean visual analogue scale score in group A is 4.08 ± 0.5 and in groups B, C, and D are 3.4 ± 0.4, 3.5 ± 0.5, and 3.5 ± 0.5, respectively. The duration of analgesia in group A is 190.4 ± 20.0 and in groups B, C, and D were 322.4 ± 31.1, 319 ± 39.8 and 317.8 ± 47.5. The quality of analgesia was good in 72%-76% and excellent in 16%-28% in groups B, C, and D and poor 28% to satisfactory 72% in group A. Conclusion: Addition of 0.8 mg of nalbuphine to 0.5% bupivacaine for subarachnoid block provides excellent analgesia with longer duration of action compared with 1.6 and 2.4 mg of nalbuphine.
  3 5,373 766
A randomized, double-blind, controlled study comparing Bupivacaine 0.125% and Ropivacaine 0.125%, both with Fentanyl 2 μg/ml, for labor epidural analgesia
Snigdha Paddalwar, Manda Nagrale, Aruna Chandak, Deepti Shrivastava, Juhi Papalkar
September-December 2013, 27(3):147-153
DOI:10.4103/0970-5333.124599  
Objective: A prospective, randomized, double-blind study was conducted to compare the efficacy of Ropivacaine 0.125% and Bupivacaine 0.125%, both with Fentanyl 2 microgm/ml, in labor epidural analgesia and their effect on duration and course of labor. Background: Ropivacaine was introduced as S-enantiomer. In various human and animal studies, it was found to be less cardiotoxic and has high sensory:motor differential blocking property. Both these characteristics are beneficial for labor epidural analgesia. Materials and Methods: Sixty pregnant women of ASA grade I and II, who were primigravida or multigravida, with singleton vertex presentation in established labor were randomly selected and divided into two groups of 30 each. Group R patients received Ropivacaine 0.125% with Fentanyl 2 μg/ml and group B patients received Bupivacaine 0.125% with Fentanyl 2 μg/ml as intermittent bolus doses epidurally. After taking consent from them, epidural catheter was placed in L2-3/3-4 space, followed by administration of study drugs given as top-up doses intermittently. Maternal heart rate, systolic blood pressure (SBP), Visual Analogue Scale (VAS) score, fetal heart rate (FHR), Bromage score, level of sensory analgesia, APGAR score at 1 and 5 min, and duration of labor were recorded. Results: The groups were similar in demographic attributes and obstetric variables. Ropivacaine showed no difference in the mean VAS scores and the quality of analgesia, as compared to Bupivacaine. At 20 min, all the patients in both groups were absolutely pain free with the VAS score of 0. No patient in group R developed motor block, whereas five patients in group B developed grade 2 (mild) motor block. APGAR scores were comparable in both the groups. Conclusion: We conclude that Ropivacaine is equipotent, produces less motor block, has no adverse effect on the course and duration of labor, and can be used safely.
  3 3,976 562
Prevalence of low back pain and its relation to quality of life and disability among women in rural area of Puducherry, India
Guna Sankar Ahdhi, Revathi Subramanian, Ganesh Kumar Saya, Thiruvanthipuram Venkatesan Yamuna
May-August 2016, 30(2):111-115
DOI:10.4103/0970-5333.186467  
Background: The level of quality of life (QOL) and disability among women with low back pain is an important health issue at global level. Objective: To find out the prevalence of low back pain and to assess the relationship of low back pain with disability and QOL among women. Materials and Methods: A community-based cross-sectional study was conducted among 250 women in age group of 30-65 years residing in field practice area of a Tertiary Care Medical Institution, Puducherry. Severity of the pain was assessed using Numerical Pain Scale. Modified Oswestry Low Back Pain Disability Questionnaire was used to measure the disability level and WHO-BREF scale to assess the QOL among women with low back pain. Results: Overall, the prevalence of low back pain was found to be 42%. The majority of women (60.9%) with low back pain experienced moderate disability. Almost 72% of women with low back pain perceived their QOL as good and overall mean QOL score was 88.41 (standard deviation = 12.9). The low back pain was influenced by the demographic variables that include age, marital status, illiteracy, total family income, type of delivery, number of children and household chores, menopausal status, and chronic illness (P < 0.05). Disability was influenced by age, education, and occupation, whereas QOL was influenced by education of the women with low back pain (P < 0.05). Conclusions: Prevalence of low back pain among women was comparatively more than other studies in India. Although moderate disability was more among those with low back pain, overall QOL was good.
  3 9,254 855
Randomized controlled trial to study the effect of dexamethasone as additive to ropivacaine on duration of ultrasound-guided transversus abdominis plane block in cesarean section
Jasleen Sachdeva, Ashok Sinha
September-December 2016, 30(3):181-185
DOI:10.4103/0970-5333.198056  
Background: Transversus abdominis plane (TAP) block is a regional anesthesia technique whose efficacy has been proven for postoperative pain relief after cesarean section (CS). Dexamethasone, a glucocorticoid, is now emerging as a new adjunct to local anesthetics for prolonging the duration of action and has been studied in different brachial plexus blocks. The primary outcome was to study the effect of dexamethasone as additive to ropivacaine on the duration of TAP block as assessed by time to first analgesic (TFA) . The secondary outcome was total postoperative analgesic consumption, postoperative nausea and vomiting, and patient satisfaction. Method: This RCT was conducted on seventy American Society of Anesthesiology Grade I and II patients undergoing CS under subarachnoid block. Patients were randomly allocated to two groups comprising 35 patients each. Patients in Group I received ultrasound-guided bilateral TAP block at the end of surgery using 40 ml ropivacaine 0.2% and 2 ml saline, and patients in Group II received the block using 40 ml ropivacaine 0.2% and 2 ml (8 mg) dexamethasone. Result: TFA was significantly longer in Group II (5.92 ± 1.02 vs. 3.11 ± 0.82 h, P = 0). Group II also had decreased tramadol requirement postoperatively (100.00 ± 0.00 vs. 140.00 ± 50.26 mg, P = 0.046). The incidence of nausea and vomiting was also lower (82.86% vs. 97.14%, P = 0.02318). The patient satisfaction with regard to pain relief was more (57.14% vs. 25.71%, P = 0.038). Conclusion: Addition of dexamethasone to ropivacaine in TAP block prolonged the duration of the block. There was no complication seen with TAP block in any of the patients.
  3 1,738 267
Epidural 0.5% levobupivacaine with dexmedetomidine versus fentanyl for vaginal hysterectomy: A prospective study
Kumkum Gupta, Bhawna Rastogi, Prashant K Gupta, Manish Jain, Suneeta Gupta, Deepti Mangla
September-December 2014, 28(3):149-154
DOI:10.4103/0970-5333.138447  
Background: Epidural adjuvants enhance the quality and duration of surgical anesthesia. The present study was aimed to compare the hemodynamic, sedative, and analgesia potentiating effects of dexmedetomidine versus fentanyl with epidural 0.5% levobupivacaine for vaginal hysterectomy. Patients and Methods: Sixty consented females of ASA physical status I and II aged 35-65 years weighing 55-75 kg, were double blindly randomized into two treatment groups. Patients received epidural 0.5% levobupivacaine 15 ml either with of 25 μg dexmedetomidine (Group LD) or 50 μg fentanyl (Group LF) and the total volume of study solution was kept 16 ml. Onset of analgesia at T10, sensory and motor block levels and duration of analgesia were observed. Intra-operatively, they were assessed for sedation, hemodynamic changes, respiratory efficiency, and side effects. The data obtained, was compiled systematically and analyzed statistically using Chi-square test and ANOVA. Value of P < 0.05 is considered significant. Result: The demographic profile was comparable between groups. The onset of sensory analgesia at T10 (7.25 ± 2.3 versus 9.27 ± 2.79 min) and time to achieve complete motor blockade (19.27 ± 4.7 versus 22.78 ± 5.57 min) was significantly earlier in patients of LD Group. The intraoperative hemodynamic changes were comparable between groups. Ramsey Sedation score was better in LD group with statistically significance. Postoperative analgesia was significantly prolonged in LD Group. Incidence of nausea, vomiting, and pruritus was high in LF group. Conclusion: Dexmedetomidine was better than fentanyl as an epidural adjuvant for providing early onset of sensory analgesia, adequate sedation with no respiratory depression and prolonged postoperative analgesia.
  3 4,251 547
REVIEW ARTICLES
Pain after craniotomy: A time for reappraisal?
Pradipta Saha, Suman Chattopadhyay, A Rudra, Sourabh Roy
January-April 2013, 27(1):7-11
DOI:10.4103/0970-5333.114853  
Until recently, perioperative pain management in neurosurgical patients has been inconsistently recognized and inadequately treated. An increased awareness of pain management in general along with advances in the understanding of pain modulation and pathophysiology, has led to improved practice and perioperative care of patients following craniotomy. Otherwise, severe postoperative pain impairs the quality of recovery and causes emotional distress with the possibility of inducing chronic pain and lasting functional deficits. The greatest challenge in managing neurosurgical patients is the need to assess the neurological function while providing superior analgesia with minimal side effects. To achieve this goal, a multimodal approach to analgesia, using various drugs and techniques, is advocated. There still remains a need, however, to conduct further randomized, controlled trials, to determine the best combination of drugs or techniques for treating perioperative pain in this patient population. Improved awareness, assessment, and treatment of pain result in better care and overall patient outcome.
  3 4,907 566
Pre-emptive analgesia: Recent trends and evidences
Amiya K Mishra, Mumtaz Afzal, Siddhartha S Mookerjee, Kasturi H Bandyopadhyay, Abhijit Paul
September-December 2013, 27(3):114-120
DOI:10.4103/0970-5333.124582  
Preemptive analgesia, initiated before the surgical procedure to prevent pain in the early postoperative period has the potential to be more effective than a similar analgesic treatment initiated after surgery. This article aims to review all the recent published evidences that assess the efficacy of this enigmatic concept. Materials and Methods: We reviewed original research articles, case-reports, meta-analyses, randomized control trials (RCTs), and reviews based on pain physiology for preemptive analgesia from Medline, Medscape, and PubMed from 1993 to 2013. A broad free-text search in English was undertaken with major keywords "Preemptive analgesia," "postoperative pain," "preoperative," and "preincisional". Results: Review of publications showed that intravenous (IV) nonsteroidal anti-inflammatory drugs (NSAIDs) are quite effective when used alone, as well as with low dose iv ketamine, preemptively to provide adequate postoperative analgesia. However, ketamine has a doubtful role as a standalone agent. Preemptive administration of LA at the incision site reduces postoperative pain, but achieves an analgesic effect similar to that of postincisional anesthetic infiltration as does intraperitoneal administration. Preemptive epidural analgesia has proved its efficacy in controlling perioperative immune function and pain in comparison to parenteral opioids. Gamma-amino butyric acid (GABA) analogues like gabapentin and pregabalin have great potential as preemptive analgesic with the added advantage of its anxiolytic effect. Conclusion: Multimodal approaches that address multiple sites along the pain pathway is necessary to treat pain adequately. However, we need to find an answer to the question of how to obtain the maximal clinical benefits with the use of preemptive analgesia.
  3 16,745 3,945
CASE REPORTS
Prolonged knee pain relief by saphenous block (new technique)
Rajeev Harshe
January-April 2013, 27(1):36-40
DOI:10.4103/0970-5333.114871  
Pain in the knee joint can be from a variety of reasons. It can be either from the joint itself, it can be myofascial or it can be neuropathy, radicular pain. The myofascial component can be in different forms, namely, collateral ligament pain, bursitis, tendinitis, and so on. This responds well to local injections of steroids. Pain from the joint can be because of osteoarthritis (OA), rheumatoid arthritis or any other variety of arthritis. Among these osteoarthritis is the most common and naturally occurring pain. There are several modalities used for managing pain in the knee joint. They include medicines and physiotherapy, intra-articular steroid injection, intra-articular Hyalgan, Synvisc injection, prolotherapy, genicular nerve block, ablation, intra-articular pulsed radio frequency (PRF) ablation, acupuncture, injection of platelet-rich plasma in the joint, total knee replacement, high tibial osteotomy, arthroscopy and lavage, and so on. All these modalities have their pros and cons. Literature and experience state that the pain relief provided may last for a few months with these modalities except in surgical interventions in advanced OA. The saphenous nerve is termination of femoral nerve and it is essentially sensory nerve. It supplies the medial compartment and some part of the anterior compartment of the knee joint. This nerve has been blocked near the knee joint by way of infiltration by surgeons and anesthetists, for relief of pain after knee surgery, with varying pain relief of postoperative pain. When we block the saphenous in the mid thigh in the sartorial canal, the fluid tends to block the medial branch of the anterior femoral cutaneous nerve also. It is hypothesized that this may give complete medial and anterior knee pain relief and as most of the knee OA patients have medial and anterior knee pain, this may prove useful. Use of ultrasonography helps to locate the nerve better, ensuring perfection. An effort has been made to block this nerve in the sartorial canal with steroid and LA under ultrasonography (USG) guidance and observe the results. Patients have received very good pain relief (95 - 100%) for a substantially long time (up to four years).
  2 14,885 966
ORIGNAL ARTICLES
The effect of two different swinging methods upon colic and crying durations among the infants
Gamze Yilmaz, Duygu Arikan
September-December 2015, 29(3):172-180
DOI:10.4103/0970-5333.159785  
Context: Swinging "repetitive and rhythmic" movements are helpful because these provide a continuous stimulus. These methods are reported to be effective upon decreasing baby's pains or cry. Aim: The purpose of this study was to determine the factors of the two different methods (rhythmic rocking of infants in the arm and rhythmic rocking infants on a blanket) on crying duration and colic as well as the factors affecting duration of crying with colic. Materials and Methods: A pre-test post-test quasi experimental model was used. Subjects included 72 infants (1-3 months) who had colic and their mothers. The infants were healthy and were delivered after full-term gestation. Results: It has been determined that as the duration of application increased (at the end of the second week), the crying duration of babies who were in each of the two groups decreased. Conclusion: It has been found that swinging ( rhythmic rocking) the infants on a blanket and in arm, decreased the colic and crying duration of infants.
  2 1,986 195
A study of 'cough trick' technique in reducing vaccination prick pain in adolescents
Vikram S. Kumar, Sangeeta V. Budur, Girish H. Odappa
May-August 2014, 28(2):95-98
DOI:10.4103/0970-5333.132847  
Background: The 'cough trick' (CT) technique is used in reducing intramuscular prick (IMP) pain during vaccinations and also for brief painful procedures like subcutaneous injection, intravenous cannulation, and so forth. We present the utility study of this technique in male adolescents. Materials and Methods: A Randomized Crossover Volunteer Study of 50 early adolescent male children (age 11-13) receiving immunizations was performed. Participants were recruited from four outpatient pediatric clinics. The strategy required a single "warm-up" cough of moderate force, followed by a second cough that coincided with needle puncture. The principle outcome was self-reported pain. Results: Paired 't' test revealed that the procedure was effective at a statistically and clinically significant level for participants. Children found the procedure acceptable and effective. Conclusions: The results of this study suggest that the CT can be an effective strategy for the reduction of pain for male adolescent children undergoing routine immunizations. However, additional research is needed with a larger sample size with different age groups and also including girl children.
  2 3,552 326
Pre-emptive use of Gabapentin for post-operative pain relief in upper abdominal surgeries
Chetna A. Jadeja, Rashida Jadaliwala, Manoj Kathiria
May-August 2014, 28(2):99-104
DOI:10.4103/2231-1505.132848  
Background: Pain of upper abdominal surgeries not only distresses the patient but also results in inadequate respiratory efforts and cough reflex. So pain relief in these surgeries bears more significance than mere patient comfort. Gabapentine has been found effective for post-operative pain relief in many surgeries including spine surgeries, radical mastectomies etc. We carried out this study to find out the effectiveness of gabapentine for post-operative pain relief in upper abdominal surgeries. Materials and Methods: The present study was randomized, double-blind and prospective, designed to evaluate synergistic effect of gabapentine and total requirement of tramadol in various upper abdominal surgeries. The study was carried out in 50 patients of American Society of Anesthesiologists (ASA) grade I and II of either sex, aged between 20 to 60 years, divided into two groups of 25 patients each. Group P (placebo group) received oral placebo capsule (3 placebo capsule) and Group G (study group) received oral gabapentine capsule (1200 mg) (3 capsules of 400 mg each) pre-operatively 2 hrs before surgery. Patients were observed 24 hrs postoperatively for pain via visual analog scale (VAS), tramadol requirement (consumption) and side effects. Results: It was observed that patients in gabapentine group had statistically significant lower pain score at all time interval in comparison to placebo group. It was demonstrated that pre-emptive oral gabapentine significantly reduced tramadol consumption until 24 hrs post-operatively. Mild sedation was observed in gabapentine group but was comparable with Group P. Conclusion: Gabapentine significantly reduces post-operative pain and post-operative tramadol consumption in upper abdominal surgeries. Mild sedation was observed with gabapentine group but was comparable with placebo.
  2 2,608 298
REVIEW ARTICLES
Pain and inflammation: Management by conventional and herbal therapy
David Arome, Akpabio Inimfon Sunday, Edith Ijeoma Onalike, Agbafor Amarachi
January-April 2014, 28(1):5-12
DOI:10.4103/0970-5333.128879  
The sensation of pain is an indication that something is wrong somewhere in the body. Pain and inflammation may be linked by cyclooxygenase (COX) enzymes most especially COX 2 , which help in the synthesis of prostaglandins (PGs) precisely PGE2 and PGF2a, found in high concentration at the inflammatory site. The released PGs either stimulate pain receptor or sensitized pain receptors to the action of other pain producing substances such as histamine, 5-hydroxytryptamine (5HT), bradykinin which initiate and cause the nerve cells to send electrical pain impulse to the brain. In the present review, an attempt is made to unveil the treatment approach adopted in the management of pain and inflammation as well as animal models used in evaluating herbal plants with analgesic and anti-inflammatory properties. The choice of the use of herbal medicine have been encouraged due to it availability, affordability, accessibility, and little or no side effect associated with it. However, the question remains can herbal therapy serves as an alternative to available conventional drugs. Different treatment options in the management of pain and inflammation have been highlighted.
  2 3,895 432
EDITORIAL
Ion channel gene mutation and pain
Debjyoti Dutta, Chinmoy Roy
May-August 2014, 28(2):59-60
DOI:10.4103/0970-5333.132839  
  1 1,615 249
ORIGNAL ARTICLES
Analgesic effect of ethanolic leaf extract of moringa oleifera on albino mice
Ayon Bhattacharya, Divya Agrawal, Pratap Kumar Sahu, Sanjay Kumar, Sudhanshu Sekhar Mishra, Shantilata Patnaik
May-August 2014, 28(2):89-94
DOI:10.4103/0970-5333.132846  
Objectives: Moringa oleifera is a highly valued plant distributed in many countries of the tropic and subtropics. Moringa oleifera leaves are a potential source of phytochemical ingredients claimed to have analgesic property. Pain is an unpleasant sensation, which in many cases represents the only symptom for the diagnosis of several diseases. Therefore analgesic drugs lacking the side effect as alternative to nonsteroidal anti-inflammatory drugs (NSAIDs) and opiates are in demand by the society. The present study is undertaken to evaluate the analgesic activity of Moringa oleifera using acetic acid induced writhing test and Eddy's hot plate test. Materials and Methods: It is a randomized control study. The present study was done using two experimental models. The albino mice were divided into six groups, each group consisting of 6 mice. A total of 36 mice were used in each of the two experimental models. Group I: Control (normal saline given orally at 2 ml/kg body weight); Group II: Standard (diclofenac 10 mg/kg i.p/ morphine 1 mg/kg i.p); Group III, IV, V, VI (ethanolic extract of Moringa oleifera (EMO) 50, 100, 200, 400 mg/kg, respectively). The EMO leaves were administered at 50, 100, 200, 400 mg/kg doses orally 1 hour before the experiments. For peripheral analgesic effect, acetic acid induced writhing test was used. The central analgesic effect was screened using Eddy's hot plate method. The standard drug used in acetic acid induced writhing test was diclofenac and in Eddy's hot plate test was morphine. Results: The EMO leaf showed significant (P < 0.01) analgesic activity at 100, 200, 400 mg/kg in the acetic acid induced writhing test showing 32.21%, 59.71% and 78.61% inhibition of writhes, respectively in comparison with the control. In the Eddy's hot plate test EMO at 400 mg/kg showed significant (P < 0.01) analgesic activity from 15 min to 90 min with a mean rank ranging from 28.92 to 26.00, second mean rank following morphine in comparison with control. In both the tests, EMO showed significant (P < 0.01) analgesic activity in a dose-dependent manner. Conclusion: The ethanolic leaf extract of Moringa oleifera exhibited analgesic activity in both models showing its both central and peripheral analgesic actions.
  1 5,741 617
The effect of fascia iliaca compartment block versus gabapentin on postoperative pain and morphine consumption in femoral surgery, a prospective, randomized, double-blind study
Abdolreza Najafi Anaraki, Kamran Mirzaei
May-August 2014, 28(2):111-116
DOI:10.4103/0970-5333.132852  
Background and Objective: Pain, after orthopedic surgery, is a severe and leading cause of chronic pain with many attempts to reduce it without a total success. Gabapentin is effective in reducing acute and chronic pain. Fascia iliaca compartment block (FICB) is a simple, rapid, effective, and safe method of achieving excellent pain relief. The purpose of this study is to compare effect of pre-emptive gabapentin with FIC on reducing postoperative pain and morphine consumption in femoral surgery. Materials and Methods: Seventy-eight patients scheduled for elective open reduction internal fixation of femur were enrolled in the study and separated into two groups. The control group received 600 mg of gabapentin orally two hours before surgery and the case group received FICB under general anesthesia. Data, including blood pressure, heart rate, sedation score, visual analogous scale at several hours and first need to analgesic post operatively was collected. Results: The post operation pain in FICB group was significantly lower than gabapentin group (P = 0.000). Patients in FICB group had more of postoperative satisfaction and the time of first need of analgesic and total analgesic consumption was significantly lower than gabapentin group (P < 0.05). There were no significant differences in complications among the study groups. Conclusion: Fascia iliaca compartment block is a safe, low skill and inexpensive way to reduce postoperative pain after femur surgery in the first hours of postoperative and can be a part of multi-modal therapy with no side effects.
  1 2,136 257
REVIEW ARTICLES
Labor epidural analgesia: Past, present and future
Reena , Kasturi H. Bandyopadhyay, Mumtaz Afzal, Amiya K. Mishra, Abhijit Paul
May-August 2014, 28(2):71-81
DOI:10.4103/0970-5333.132843  
One of the most severe pains experienced by a woman is that of childbirth. Providing analgesia for labor has always been a challenge more so because of the myths and controversies surrounding labor. It is imperative to understand the pain transmission during various stages of labor in order to select a proper technique for providing labor analgesia. The adverse effects of labor pain are numerous and affect both the mother as well as the fetus. Currently lumbar epidural is considered to be the gold standard technique for labor analgesia. Local anaesthetics like bupivacaine and ropivacaine are commonly used and adjuvants like clonidine, fentanyl and neostigmine have been extensively studied. However, despite being so popular, epidural analgesia is not without complications, with hypotension being the most common. Other complications include accidental dural puncture, infection, intravascular placement, high block and epidural hematoma. Other neuraxial techniques include continuous caudal analgesia, and combined spinal epidural analgesia. The numerous studies investigating the various aspects of this method have also served to dispel various myths surrounding epidural analgesia like increased incidence of cesarean section and instrumental delivery, prolongation of labor and future back pain. The future of labor analgesia lies in the incorporation of ultrasound in identifying the epidural space helping in proper catheter placement. The keywords "labor epidural" in the PUBMED revealed a total of 5018 articles with 574 review articles and 969 clinical trials. The relevant articles along with their references were extensively studied.
  1 14,812 2,040
* Source: CrossRef
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