Total knee arthroplasty (TKA) associated with moderate-to-severe surgical site pain postoperatively requires multimodal analgesia for which adductor canal block (ACB) is an effective modality. The aim of this study was to compare the analgesic efficacy of continuous versus single-shot ACB in patients undergoing unilateral TKA. It was a prospective randomized controlled trial carried out in a tertiary care hospital. Sixty patients (18–65 years) undergoing unilateral TKA were prospectively randomized into continuous (CACB) and single (SACB) shot adductor canal blockade groups. Postoperative ultrasound-guided ACB was given, and the Visual Analog Scale (VAS) scores, time to first rescue analgesia, and total amount of analgesia required in 24 and 48 h were noted. Straight leg raise (SLR) test and maximum knee extension test were performed to check for quadriceps muscle strength. Both the groups were compared using appropriate statistical tests, with P < 0.05 considered statistically significant. In both the demographically comparable groups, VAS scores were similar at 0, 4, 8, and 12 h postsurgery, but higher in the SACB group at 24 (P < 0.0001) and 48 h (P = 0.02), needing rescue analgesia in 4 out of 30 patients. One out of 30 patients of the SACB group could not perform the SLR test on the 1st postoperative day. Knee extension was present in all 60 patients. ACB is a pure sensory block. CACB provides a longer duration of analgesia; however, SACB can be an equally useful alternative in resource-limited settings, to avoid catheter dislodgement, risk of infection, and need for continuous monitoring.
{"title":"Comparison of Analgesic Efficacy of Continuous Adductor Canal Block versus Single-shot Adductor Canal Block Using Ropivacaine for Unilateral Total Knee Arthroplasty: A Randomized Controlled Trial","authors":"Ashish Choudhary, Arushi Gupta, Ameeta Sahni, Khushboo Mehta","doi":"10.4103/ijpn.ijpn_32_23","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_32_23","url":null,"abstract":"\u0000 \u0000 \u0000 Total knee arthroplasty (TKA) associated with moderate-to-severe surgical site pain postoperatively requires multimodal analgesia for which adductor canal block (ACB) is an effective modality.\u0000 \u0000 \u0000 \u0000 The aim of this study was to compare the analgesic efficacy of continuous versus single-shot ACB in patients undergoing unilateral TKA.\u0000 \u0000 \u0000 \u0000 It was a prospective randomized controlled trial carried out in a tertiary care hospital.\u0000 \u0000 \u0000 \u0000 Sixty patients (18–65 years) undergoing unilateral TKA were prospectively randomized into continuous (CACB) and single (SACB) shot adductor canal blockade groups. Postoperative ultrasound-guided ACB was given, and the Visual Analog Scale (VAS) scores, time to first rescue analgesia, and total amount of analgesia required in 24 and 48 h were noted. Straight leg raise (SLR) test and maximum knee extension test were performed to check for quadriceps muscle strength.\u0000 \u0000 \u0000 \u0000 Both the groups were compared using appropriate statistical tests, with P < 0.05 considered statistically significant.\u0000 \u0000 \u0000 \u0000 In both the demographically comparable groups, VAS scores were similar at 0, 4, 8, and 12 h postsurgery, but higher in the SACB group at 24 (P < 0.0001) and 48 h (P = 0.02), needing rescue analgesia in 4 out of 30 patients. One out of 30 patients of the SACB group could not perform the SLR test on the 1st postoperative day. Knee extension was present in all 60 patients.\u0000 \u0000 \u0000 \u0000 ACB is a pure sensory block. CACB provides a longer duration of analgesia; however, SACB can be an equally useful alternative in resource-limited settings, to avoid catheter dislodgement, risk of infection, and need for continuous monitoring.\u0000","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"31 39","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141379532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The frozen shoulder (FS) also known as adhesive capsulitis is one of the most common causes of shoulder pain and disability. It is marked by pain and limitation of movement resulting in progressive deterioration of quality of life. Although a few patients with an FS recover without any intervention, the majority of patients have persistent pain with or without movement restriction. Ultrasound (USG)-guided hydrodistension of the shoulder joint is an upcoming mode of treatment for FS which can theoretically lead to pain relief, functional improvement, and a better quality of life, especially if combined with the anti-inflammatory effects of intra-articular corticosteroids. Here, we are presenting our experience with USG-guided hydrodistention of the shoulder joint along with intra-articular corticosteroid in cases of FS both in terms of objective indices of shoulder functionality and subjective outcomes of pain. Eight patients who presented to the outpatient department of pain medicine in our hospital having FS (stage 2/3) were selected. Outcome measures included pain score, Shoulder Pain and Disability Index (SPADI) and Shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Visual Analogue Scale, and range of movement. Data were collected at baseline, as well as at 6 weeks, 12 weeks, and 6 months. We performed hydrodistension with 30 ml of volume constituted by adding lignocaine and triamcinolone acetate to normal saline immediately, followed by physiotherapy of the shoulder joint and cryotherapy. We found promising results with all our patients both in the short term as well as long term with both SPADI and QuickDASH scores as well as the range of motion of the shoulder joint improving significantly in all eight patients at 6 weeks and 12 weeks. This improvement notably persisted in all the patients when reassessed at 6 months indicating a long-term benefit of the intervention.
{"title":"Ultrasound-Guided Hydrodistention with Corticosteroid Instillation in Glenohumeral Joint for Relief in Frozen Shoulder: A Case Series","authors":"Smita Gulati, Aparna Singh, Kush Sharma","doi":"10.4103/ijpn.ijpn_8_24","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_8_24","url":null,"abstract":"\u0000 The frozen shoulder (FS) also known as adhesive capsulitis is one of the most common causes of shoulder pain and disability. It is marked by pain and limitation of movement resulting in progressive deterioration of quality of life. Although a few patients with an FS recover without any intervention, the majority of patients have persistent pain with or without movement restriction. Ultrasound (USG)-guided hydrodistension of the shoulder joint is an upcoming mode of treatment for FS which can theoretically lead to pain relief, functional improvement, and a better quality of life, especially if combined with the anti-inflammatory effects of intra-articular corticosteroids. Here, we are presenting our experience with USG-guided hydrodistention of the shoulder joint along with intra-articular corticosteroid in cases of FS both in terms of objective indices of shoulder functionality and subjective outcomes of pain. Eight patients who presented to the outpatient department of pain medicine in our hospital having FS (stage 2/3) were selected. Outcome measures included pain score, Shoulder Pain and Disability Index (SPADI) and Shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Visual Analogue Scale, and range of movement. Data were collected at baseline, as well as at 6 weeks, 12 weeks, and 6 months. We performed hydrodistension with 30 ml of volume constituted by adding lignocaine and triamcinolone acetate to normal saline immediately, followed by physiotherapy of the shoulder joint and cryotherapy. We found promising results with all our patients both in the short term as well as long term with both SPADI and QuickDASH scores as well as the range of motion of the shoulder joint improving significantly in all eight patients at 6 weeks and 12 weeks. This improvement notably persisted in all the patients when reassessed at 6 months indicating a long-term benefit of the intervention.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"13 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141118445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vitamin D, a fat-soluble vitamin, is found in many animal products and fortified foods and is endogenously made in the human body. Vitamin D supplementation has become a part of the routine prescription; its continuous intake without any follow-up has led to hypervitaminosis D due to overdosing. Hypercalcemia accompanies hypervitaminosis D, affecting bone health, blood pressure, and kidney function. We studied six cases that landed in hypervitaminosis D due to prolonged intake.
维生素 D 是一种脂溶性维生素，存在于许多动物产品和强化食品中，可在人体内生成。维生素 D 补充剂已成为常规处方的一部分；在没有任何后续措施的情况下持续摄入维生素 D 会导致过量摄入导致维生素 D 过多症。高钙血症伴随着高维生素 D，会影响骨骼健康、血压和肾功能。我们研究了六例因长期摄入维生素 D 过量而导致维生素 D 过量症的病例。
{"title":"Hypervitaminosis D Due to Overdose: A Case Series","authors":"Shivani Rastogi, Anurag Agarwal, Raj Laxmi Bhandari, Aayushi Bagga, Brihaspati Tiwari","doi":"10.4103/ijpn.ijpn_89_23","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_89_23","url":null,"abstract":"\u0000 Vitamin D, a fat-soluble vitamin, is found in many animal products and fortified foods and is endogenously made in the human body. Vitamin D supplementation has become a part of the routine prescription; its continuous intake without any follow-up has led to hypervitaminosis D due to overdosing. Hypercalcemia accompanies hypervitaminosis D, affecting bone health, blood pressure, and kidney function. We studied six cases that landed in hypervitaminosis D due to prolonged intake.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140981532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thoracolumbar spine surgeries need multimodal analgesia to control postoperative pain and early recovery. The study is about comparing the efficacy of bilateral single-shot ultrasound-guided (USG) erector spinae plane block (ESPB) versus local anesthetic infiltration before incision in patients scheduled for spine surgeries under general anesthesia (GA). This study aimed to compare USG-guided ESPB versus local anesthetic infiltration in spine surgeries for intraoperative and postoperative analgesia. Forty patients, the American Society of Anesthesiologists I, II, and III aged 18–80 years, undergoing spine surgeries under GA were enrolled in this prospective, randomized study. Patients were randomized to two groups of 20 each. Group L received GA and local anesthetic infiltration at the incision site by the surgeon and Group E received GA and preoperative bilateral ESPB with 20 mL 0.375% bupivacaine at each site. The primary outcome was the assessment by Numeric Rating Score (NRS) and total postoperative analgesic consumption in the first 24 h. The secondary objectives were intraoperative hemodynamic stability and dexmedetomidine requirement. NRS at 4-h, 6-h, and 12-h postincision was significantly higher in Group L compared to Group E (P = 0.006, P = 00.001, and P = 00.006). The requirement of intraoperative dexmedetomidine and total doses of postoperative analgesic were significantly lower in Group E compared to Group L (P = 0.001). Patients who received ESPB showed better hemodynamic stability compared to those who received local anesthetic infiltration at the incision site. Preoperative bilateral single-shot USG-guided ESPB provides safe and effective intraoperative as well as postoperative analgesia for spine surgeries with reduced analgesic requirement.
胸腰椎手术需要多模式镇痛来控制术后疼痛并尽早恢复。本研究旨在比较在全身麻醉（GA）下计划进行脊柱手术的患者双侧单发超声引导（USG）竖脊肌平面阻滞（ESPB）与切口前局麻药浸润的疗效。 本研究旨在比较 USG 引导下的竖脊肌平面阻滞与局麻药浸润在脊柱手术中的术中和术后镇痛效果。 40 名年龄在 18-80 岁之间、在 GA 下接受脊柱手术的美国麻醉医师协会 I、II 和 III 级患者被纳入了这项前瞻性随机研究。患者被随机分为两组，每组 20 人。L 组接受 GA 并由外科医生在切口部位进行局麻药浸润，E 组接受 GA 并在术前双侧 ESPB，每个部位使用 20 mL 0.375% 布比卡因。主要结果是数字评分（NRS）和术后 24 小时镇痛剂总用量的评估，次要目标是术中血流动力学稳定性和右美托咪定需求量。 与E组相比，L组在切口后4小时、6小时和12小时的NRS明显更高（P = 0.006、P = 00.001和P = 00.006）。与 L 组相比，E 组术中对右美托咪定的需求量和术后镇痛剂的总剂量明显降低（P = 0.001）。与在切口部位接受局麻药浸润的患者相比，接受 ESPB 的患者表现出更好的血流动力学稳定性。 术前双侧单针 USG 引导 ESPB 可为脊柱手术提供安全有效的术中和术后镇痛，同时减少镇痛剂的需求量。
{"title":"A Comparative Study of Ultrasound Guided erector Spinae Plane Block versus Local Anaesthetic Infiltration in Spine Surgeries for Intraoperative and Post-operative Analgesia","authors":"Shweta A. Puntambekar, Varshali M Keniya","doi":"10.4103/ijpn.ijpn_25_23","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_25_23","url":null,"abstract":"\u0000 \u0000 \u0000 Thoracolumbar spine surgeries need multimodal analgesia to control postoperative pain and early recovery. The study is about comparing the efficacy of bilateral single-shot ultrasound-guided (USG) erector spinae plane block (ESPB) versus local anesthetic infiltration before incision in patients scheduled for spine surgeries under general anesthesia (GA).\u0000 \u0000 \u0000 \u0000 This study aimed to compare USG-guided ESPB versus local anesthetic infiltration in spine surgeries for intraoperative and postoperative analgesia.\u0000 \u0000 \u0000 \u0000 Forty patients, the American Society of Anesthesiologists I, II, and III aged 18–80 years, undergoing spine surgeries under GA were enrolled in this prospective, randomized study. Patients were randomized to two groups of 20 each. Group L received GA and local anesthetic infiltration at the incision site by the surgeon and Group E received GA and preoperative bilateral ESPB with 20 mL 0.375% bupivacaine at each site. The primary outcome was the assessment by Numeric Rating Score (NRS) and total postoperative analgesic consumption in the first 24 h. The secondary objectives were intraoperative hemodynamic stability and dexmedetomidine requirement.\u0000 \u0000 \u0000 \u0000 NRS at 4-h, 6-h, and 12-h postincision was significantly higher in Group L compared to Group E (P = 0.006, P = 00.001, and P = 00.006). The requirement of intraoperative dexmedetomidine and total doses of postoperative analgesic were significantly lower in Group E compared to Group L (P = 0.001). Patients who received ESPB showed better hemodynamic stability compared to those who received local anesthetic infiltration at the incision site.\u0000 \u0000 \u0000 \u0000 Preoperative bilateral single-shot USG-guided ESPB provides safe and effective intraoperative as well as postoperative analgesia for spine surgeries with reduced analgesic requirement.\u0000","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":" 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140996683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-19DOI: 10.4103/ijpn.ijpn_111_23
Sonal Goyal, Ajit Kumar, Manasa Kantha, Ravi Shankar Sharma, Sanjay Agrawal, Girish K. Singh
Stellate ganglion block (SGB) is effectively utilized in various sympathetically mediated pain conditions of head and neck, upper limb such as complex regional pain syndrome, postherpetic neuralgias, but there has been a paucity of evidence of SGB for the management of phantom limb pain (PLP). Ten upper extremity PLP patients underwent ultrasound-guided SGB block. Under real-time needle tip visualization and after ensuring negative aspiration, 5 mL of 1% lignocaine and 4 mg of dexamethasone were injected. Postprocedure pain score (numerical rating scale [NRS]) and patient satisfaction score (Likert scale) were noted, and patients were followed-up for the next 60 days. The baseline NRS score (Mean [standard deviation]) of 7.8 (0.748) showed significant reduction (P < 0.001) to 2.8 (0.748) at immediate postinjection, to 2.6 (0.663) at day 7, at day 30 (2.9 [0.7]), and at day 60 (30.775). Most of the patients (80%–90%) were somewhat to very much satisfied with the treatment response (score 4–5 on Likert scale) at all the follow-up intervals. Only mild and transient adverse events were demonstrated in two patients who developed hoarseness of voice. Ultrasound-guided SGB effectively reduces pain and improves patient satisfaction in postamputee patients who developed PLP, over 2 months of the follow-up period. Further prospective randomized controlled trials over a larger duration with more sample size are needed to provide more concrete evidence.
{"title":"Ultrasound-guided Stellate Ganglion Block for Upper Extremity Phantom Limb Pain - A Case Series","authors":"Sonal Goyal, Ajit Kumar, Manasa Kantha, Ravi Shankar Sharma, Sanjay Agrawal, Girish K. Singh","doi":"10.4103/ijpn.ijpn_111_23","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_111_23","url":null,"abstract":"\u0000 \u0000 \u0000 Stellate ganglion block (SGB) is effectively utilized in various sympathetically mediated pain conditions of head and neck, upper limb such as complex regional pain syndrome, postherpetic neuralgias, but there has been a paucity of evidence of SGB for the management of phantom limb pain (PLP).\u0000 \u0000 \u0000 \u0000 Ten upper extremity PLP patients underwent ultrasound-guided SGB block. Under real-time needle tip visualization and after ensuring negative aspiration, 5 mL of 1% lignocaine and 4 mg of dexamethasone were injected. Postprocedure pain score (numerical rating scale [NRS]) and patient satisfaction score (Likert scale) were noted, and patients were followed-up for the next 60 days.\u0000 \u0000 \u0000 \u0000 The baseline NRS score (Mean [standard deviation]) of 7.8 (0.748) showed significant reduction (P < 0.001) to 2.8 (0.748) at immediate postinjection, to 2.6 (0.663) at day 7, at day 30 (2.9 [0.7]), and at day 60 (30.775). Most of the patients (80%–90%) were somewhat to very much satisfied with the treatment response (score 4–5 on Likert scale) at all the follow-up intervals. Only mild and transient adverse events were demonstrated in two patients who developed hoarseness of voice.\u0000 \u0000 \u0000 \u0000 Ultrasound-guided SGB effectively reduces pain and improves patient satisfaction in postamputee patients who developed PLP, over 2 months of the follow-up period. Further prospective randomized controlled trials over a larger duration with more sample size are needed to provide more concrete evidence.\u0000","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"16 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140450585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fascia iliaca compartment block (FICB) is a useful modality to provide postoperative analgesia in patients with hip fracture undergoing surgery. The aims of this study were to compare the analgesic efficacy of suprainguinal versus infrainguinal approach of ultrasound-guided FICB using 0.2% ropivacaine in patients undergoing surgery for hip fracture under spinal anesthesia. It was a prospective, randomized, controlled study. Group A (n = 25) received ultrasound-guided FICB by suprainguinal approach and Group B (n = 25) received ultrasound-guided FICB by infrainguinal approach. The primary objective was to compare 24-h postoperative analgesic efficacy using Numeric Rating Scale (NRS) score. For data analysis, t-test, Mann–Whitney test, and Chi-square test were applied. NRS score after 30 min of FICB in Group A was 2.36 ± 1.11 which was lower in comparison to 3.28 ± 0.94 in Group B (P = 0.002). NRS score during positioning in Group A was 2.16 ± 0.90, which was lower than Group B 3.08 ± 0.81 (P = 0. 0004). Greater block coverage was achieved in obturator nerve distribution in Group A 0.76 ± 0.52 compared to 0.16 ± 0.37 in Group B (P < 0.001). The total duration of analgesia was 493.40 ± 214.83 min, which was more in Group A than in Group B 367.48 ± 63.92 min (P = 0.007). Quality of recovery (QoR) score out of 150 in Group A was 120.60 ± 8.91 compared to 110.40 ± 7.59 in Group B (P < 0.001). FICB by suprainguinal approach provides better analgesia, sensory block coverage, and conditions for positioning for spinal anesthesia and also has a higher time to first rescue analgesic requirement with better QoR compared to infrainguinal approach.
{"title":"A Comparative Study of Postoperative Analgesic Efficacy of Suprainguinal versus Infrainguinal Approach of Ultrasound-guided Fascia Iliaca Compartment Block using 0.2% Ropivacaine in Patients Undergoing Surgery for Hip Fracture under Spinal Anesthesia","authors":"P. Mathur, Ananda Prakash Banerjee, R. Yadav","doi":"10.4103/ijpn.ijpn_30_23","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_30_23","url":null,"abstract":"\u0000 \u0000 \u0000 Fascia iliaca compartment block (FICB) is a useful modality to provide postoperative analgesia in patients with hip fracture undergoing surgery.\u0000 \u0000 \u0000 \u0000 The aims of this study were to compare the analgesic efficacy of suprainguinal versus infrainguinal approach of ultrasound-guided FICB using 0.2% ropivacaine in patients undergoing surgery for hip fracture under spinal anesthesia.\u0000 \u0000 \u0000 \u0000 It was a prospective, randomized, controlled study.\u0000 \u0000 \u0000 \u0000 Group A (n = 25) received ultrasound-guided FICB by suprainguinal approach and Group B (n = 25) received ultrasound-guided FICB by infrainguinal approach. The primary objective was to compare 24-h postoperative analgesic efficacy using Numeric Rating Scale (NRS) score.\u0000 \u0000 \u0000 \u0000 For data analysis, t-test, Mann–Whitney test, and Chi-square test were applied.\u0000 \u0000 \u0000 \u0000 NRS score after 30 min of FICB in Group A was 2.36 ± 1.11 which was lower in comparison to 3.28 ± 0.94 in Group B (P = 0.002). NRS score during positioning in Group A was 2.16 ± 0.90, which was lower than Group B 3.08 ± 0.81 (P = 0. 0004). Greater block coverage was achieved in obturator nerve distribution in Group A 0.76 ± 0.52 compared to 0.16 ± 0.37 in Group B (P < 0.001). The total duration of analgesia was 493.40 ± 214.83 min, which was more in Group A than in Group B 367.48 ± 63.92 min (P = 0.007). Quality of recovery (QoR) score out of 150 in Group A was 120.60 ± 8.91 compared to 110.40 ± 7.59 in Group B (P < 0.001).\u0000 \u0000 \u0000 \u0000 FICB by suprainguinal approach provides better analgesia, sensory block coverage, and conditions for positioning for spinal anesthesia and also has a higher time to first rescue analgesic requirement with better QoR compared to infrainguinal approach.\u0000","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"380 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140459565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Barasker, Pankaj Singhai, Swati Mulye, Anuj Jain, Dipti Saxena
Injury to the sciatic nerve from dorsogluteal intramuscular (IM) injection is not an uncommon iatrogenic cause. This case report discusses the successful management of a child with sciatic nerve injury due to an IM injection in the left gluteal region. The child experienced severe pain that was not responding to pharmacological therapy and was limiting physiotherapy, which forms an important step in the management of patients with peripheral nerve injuries. The case report outlines the use of a posterior tibial nerve block, which provided immediate relief of pain sensations in the sole of the foot, allowing the child to walk and eventually improving sleep and appetite. The report suggests that distal nerve blocks may be an effective treatment option for patients with severe neuropathic symptoms resulting from peripheral nerve injury.
{"title":"Pain Management of Sciatic Nerve Injury Induced by Intramuscular Injection Using Distal Nerve Block","authors":"S. Barasker, Pankaj Singhai, Swati Mulye, Anuj Jain, Dipti Saxena","doi":"10.4103/ijpn.ijpn_70_23","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_70_23","url":null,"abstract":"\u0000 Injury to the sciatic nerve from dorsogluteal intramuscular (IM) injection is not an uncommon iatrogenic cause. This case report discusses the successful management of a child with sciatic nerve injury due to an IM injection in the left gluteal region. The child experienced severe pain that was not responding to pharmacological therapy and was limiting physiotherapy, which forms an important step in the management of patients with peripheral nerve injuries. The case report outlines the use of a posterior tibial nerve block, which provided immediate relief of pain sensations in the sole of the foot, allowing the child to walk and eventually improving sleep and appetite. The report suggests that distal nerve blocks may be an effective treatment option for patients with severe neuropathic symptoms resulting from peripheral nerve injury.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139790998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Barasker, Pankaj Singhai, Swati Mulye, Anuj Jain, Dipti Saxena
Injury to the sciatic nerve from dorsogluteal intramuscular (IM) injection is not an uncommon iatrogenic cause. This case report discusses the successful management of a child with sciatic nerve injury due to an IM injection in the left gluteal region. The child experienced severe pain that was not responding to pharmacological therapy and was limiting physiotherapy, which forms an important step in the management of patients with peripheral nerve injuries. The case report outlines the use of a posterior tibial nerve block, which provided immediate relief of pain sensations in the sole of the foot, allowing the child to walk and eventually improving sleep and appetite. The report suggests that distal nerve blocks may be an effective treatment option for patients with severe neuropathic symptoms resulting from peripheral nerve injury.
{"title":"Pain Management of Sciatic Nerve Injury Induced by Intramuscular Injection Using Distal Nerve Block","authors":"S. Barasker, Pankaj Singhai, Swati Mulye, Anuj Jain, Dipti Saxena","doi":"10.4103/ijpn.ijpn_70_23","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_70_23","url":null,"abstract":"\u0000 Injury to the sciatic nerve from dorsogluteal intramuscular (IM) injection is not an uncommon iatrogenic cause. This case report discusses the successful management of a child with sciatic nerve injury due to an IM injection in the left gluteal region. The child experienced severe pain that was not responding to pharmacological therapy and was limiting physiotherapy, which forms an important step in the management of patients with peripheral nerve injuries. The case report outlines the use of a posterior tibial nerve block, which provided immediate relief of pain sensations in the sole of the foot, allowing the child to walk and eventually improving sleep and appetite. The report suggests that distal nerve blocks may be an effective treatment option for patients with severe neuropathic symptoms resulting from peripheral nerve injury.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"53 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139850710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Subrata Ray, Anuradha Mitra, R. Sanyal, Tabish Hussain, Anjum Naz
Immediate post-operative pain can be severe and is an important outcome measure for patients in shoulder arthroscopic surgeries. Interscalene block is the most widely used and studied technique for post shoulder arthroscopy pain relief and is associated with certain unpleasant adverse effects. Suprascapular nerve block (SSNB) has been suggested as an alternative and safer block. As the suprascapular nerve contributes to 70% of the sensory nerve supply to the shoulder joint, and the axillary circumflex nerve is the other major nerve contributing to 25%; therefore, a combined block of these two nerves should provide more effective pain relief than SSNB alone. This study aimed to compare the efficacy of combined SSNB and axillary nerve block (ANB) with SSNB alone for analgesia after shoulder arthroscopy in terms of level of pain scores, total analgesic consumption, and patient satisfaction in 24 h. Forty-one patients posted for shoulder arthroscopy were randomly allocated into two groups, Group S (n = 20) receiving SSNB and Group C (n = 21) receiving combined SSNB and ANB. Visual Analog Scale (VAS) both at rest and during movement at 1, 3, 6, 12, 24 h, and at the time of first demand, total consumption of analgesics in 24 h and patient satisfaction score at 12 and 24 h were noted. The data was analyzed by Student’s t-test, Mann-Whitney U test, and Fisher’s exact test using Graph Pad PRISM 9, a p<0.05 was considered significant. The VAS scores both at rest and during movement were significantly less in Group C at 1, 6, 12 h, and at the time of the first demand of analgesic (p<0.05). Compared to Group S, Group C had a longer pain-free duration (154.3 ± 11.41 min vs. 36.60 ± 6.553 min; P < 0.001) and lesser cumulative consumption of pethidine (300.0 ± 8.894 mg vs. 336.8 ± 13.27 mg; P = 0.0256). The satisfaction level was better in Group C at 12 h (P = 0.002) but comparable to the Group S at 24 h (P = 0.0673). Combined SSNB and ANB provided better pain relief in first 12 h, better patient satisfaction in the first 12 h and decreased overall consumption of analgesics in the first 24 h compared to SSNB alone.
术后即刻疼痛可能很严重，是衡量肩关节镜手术患者疗效的一个重要指标。肩胛间神经阻滞是肩关节镜术后止痛最广泛使用和研究的技术，但也会带来一些令人不快的不良反应。肩胛上神经阻滞（SSNB）被认为是一种更安全的替代阻滞方法。由于肩胛上神经占肩关节感觉神经供应的 70%，而腋窝圆周神经是另一条主要神经，占 25%；因此，联合阻滞这两条神经应该比单独阻滞 SSNB 能更有效地缓解疼痛。 本研究旨在比较联合 SSNB 和腋神经阻滞（ANB）与单独 SSNB 在肩关节镜术后 24 小时内的疼痛评分、总镇痛剂消耗量和患者满意度方面的镇痛效果。记录休息时和运动时 1、3、6、12、24 小时的视觉模拟量表（VAS）、首次需求时的视觉模拟量表（VAS）、24 小时内止痛药的总消耗量以及 12 和 24 小时内患者的满意度评分。 数据分析采用学生 t 检验、曼-惠特尼 U 检验和费雪精确检验（Graph Pad PRISM 9），P<0.05 为差异显著。 C 组在 1、6、12 h 和首次需要镇痛剂时的静息和运动时的 VAS 评分均明显低于 S 组（P<0.05）。与 S 组相比，C 组的无痛持续时间更长（154.3 ± 11.41 分钟 vs 36.60 ± 6.553 分钟；P < 0.001），哌替啶的累计用量更少（300.0 ± 8.894 毫克 vs 336.8 ± 13.27 毫克；P = 0.0256）。12 小时后，C 组的满意度更高（P = 0.002），但 24 小时后与 S 组相当（P = 0.0673）。 与单独使用 SSNB 相比，联合使用 SSNB 和 ANB 可更好地缓解头 12 小时的疼痛，提高患者头 12 小时的满意度，并减少头 24 小时镇痛药的总用量。
{"title":"Analgesic Efficacy of Suprascapular Nerve Block versus Combined Suprascapular and Axillary Nerve Block in Patients Undergoing Shoulder Arthroscopy: A Prospective, Randomized, Comparative Study","authors":"Subrata Ray, Anuradha Mitra, R. Sanyal, Tabish Hussain, Anjum Naz","doi":"10.4103/ijpn.ijpn_73_23","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_73_23","url":null,"abstract":"\u0000 \u0000 \u0000 Immediate post-operative pain can be severe and is an important outcome measure for patients in shoulder arthroscopic surgeries. Interscalene block is the most widely used and studied technique for post shoulder arthroscopy pain relief and is associated with certain unpleasant adverse effects. Suprascapular nerve block (SSNB) has been suggested as an alternative and safer block. As the suprascapular nerve contributes to 70% of the sensory nerve supply to the shoulder joint, and the axillary circumflex nerve is the other major nerve contributing to 25%; therefore, a combined block of these two nerves should provide more effective pain relief than SSNB alone.\u0000 \u0000 \u0000 \u0000 This study aimed to compare the efficacy of combined SSNB and axillary nerve block (ANB) with SSNB alone for analgesia after shoulder arthroscopy in terms of level of pain scores, total analgesic consumption, and patient satisfaction in 24 h.\u0000 \u0000 \u0000 \u0000 Forty-one patients posted for shoulder arthroscopy were randomly allocated into two groups, Group S (n = 20) receiving SSNB and Group C (n = 21) receiving combined SSNB and ANB. Visual Analog Scale (VAS) both at rest and during movement at 1, 3, 6, 12, 24 h, and at the time of first demand, total consumption of analgesics in 24 h and patient satisfaction score at 12 and 24 h were noted.\u0000 \u0000 \u0000 \u0000 The data was analyzed by Student’s t-test, Mann-Whitney U test, and Fisher’s exact test using Graph Pad PRISM 9, a p<0.05 was considered significant.\u0000 \u0000 \u0000 \u0000 The VAS scores both at rest and during movement were significantly less in Group C at 1, 6, 12 h, and at the time of the first demand of analgesic (p<0.05). Compared to Group S, Group C had a longer pain-free duration (154.3 ± 11.41 min vs. 36.60 ± 6.553 min; P < 0.001) and lesser cumulative consumption of pethidine (300.0 ± 8.894 mg vs. 336.8 ± 13.27 mg; P = 0.0256). The satisfaction level was better in Group C at 12 h (P = 0.002) but comparable to the Group S at 24 h (P = 0.0673).\u0000 \u0000 \u0000 \u0000 Combined SSNB and ANB provided better pain relief in first 12 h, better patient satisfaction in the first 12 h and decreased overall consumption of analgesics in the first 24 h compared to SSNB alone.\u0000","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":" 108","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139628042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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