Pub Date : 2023-09-27DOI: 10.4103/ijpn.ijpn_129_22
Pratibha Matche, Prabhakar Sathiah, S. Paneyala, Aishwarya Bajaj
Trigeminal neuralgia is the most common type of craniofacial neuralgia, characterized by paroxysmal lancinating electric shock-like pain confined to the somatosensory distribution of the trigeminal nerve. Fluoroscopy-guided Radiofrequency Ablation of Gasserian Ganglion (RFA-GG) is the commonly performed minimally invasive pain intervention in these patients. Various complications such as masseter weakness, corneal anesthesia, dysesthesia, anesthesia dolorosa, keratitis, and cranial nerve deficits have been reported during the procedure. We present the case of a 58-year-old male diagnosed with left-sided trigeminal neuralgia involving mandibular division of trigeminal nerve (V3 division) with a Numerical Rating Scale of 9/10 at the time of presentation. As the patient was unresponsive to medical management, RFA of the V3 division of GG was performed with acceptable sensory and motor stimulation. Postablation, 1 ml of 1.0% Lidocaine injection with 2 mg injection dexamethasone was given. After the procedure, the patient complained of dizziness, left-sided hearing loss, and double vision on looking toward the left side. On examination, deviation of the angle of the mouth toward the right side, reduced blink reflex on the left side, and incomplete closure of the left eyelid were observed. Vitals were stable and there was no respiratory discomfort. The patient was reassured and monitored in the recovery room. Signs and symptoms were transient and the patient recovered completely after 45 min. Clinical findings were suggestive of the involvement of three cranial nerves: the abducens nerve, the facial nerve, and the vestibulocochlear nerve. Spillage of local anesthetic solution into adjacent cranial nerves surrounding the GG might be the causative mechanism for transient cranial nerve palsies in this case.
{"title":"Expect the Unexpected!! – Transient Cranial Nerve Palsies after Radiofrequency Ablation of Gasserian Ganglion for Trigeminal Neuralgia","authors":"Pratibha Matche, Prabhakar Sathiah, S. Paneyala, Aishwarya Bajaj","doi":"10.4103/ijpn.ijpn_129_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_129_22","url":null,"abstract":"Trigeminal neuralgia is the most common type of craniofacial neuralgia, characterized by paroxysmal lancinating electric shock-like pain confined to the somatosensory distribution of the trigeminal nerve. Fluoroscopy-guided Radiofrequency Ablation of Gasserian Ganglion (RFA-GG) is the commonly performed minimally invasive pain intervention in these patients. Various complications such as masseter weakness, corneal anesthesia, dysesthesia, anesthesia dolorosa, keratitis, and cranial nerve deficits have been reported during the procedure. We present the case of a 58-year-old male diagnosed with left-sided trigeminal neuralgia involving mandibular division of trigeminal nerve (V3 division) with a Numerical Rating Scale of 9/10 at the time of presentation. As the patient was unresponsive to medical management, RFA of the V3 division of GG was performed with acceptable sensory and motor stimulation. Postablation, 1 ml of 1.0% Lidocaine injection with 2 mg injection dexamethasone was given. After the procedure, the patient complained of dizziness, left-sided hearing loss, and double vision on looking toward the left side. On examination, deviation of the angle of the mouth toward the right side, reduced blink reflex on the left side, and incomplete closure of the left eyelid were observed. Vitals were stable and there was no respiratory discomfort. The patient was reassured and monitored in the recovery room. Signs and symptoms were transient and the patient recovered completely after 45 min. Clinical findings were suggestive of the involvement of three cranial nerves: the abducens nerve, the facial nerve, and the vestibulocochlear nerve. Spillage of local anesthetic solution into adjacent cranial nerves surrounding the GG might be the causative mechanism for transient cranial nerve palsies in this case.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139335363","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}
Rajabhau Kshirsagar, S. Kuttarmare, P. Bhalerao, Sujit Kshirsagar
Background: Laparoscopic cholecystectomy is a minimally invasive procedure requiring less hospital stay and early mobilization as compared to open procedure. The aim of our study was to compare the efficacy of intraperitoneal instillation of hydrocortisone with bupivacaine for postoperative analgesia in patients undergoing laparoscopic cholecystectomy under spinal anesthesia. Materials and Methods: Sixty patients were enrolled in this prospective randomized study. Patients either received 0.125% bupivacaine (Group B) or 0.125% bupivacaine with 100 mg hydrocortisone (Group H) through intraperitoneal drain at the end of surgery. Pain was evaluated every two hourly using the Visual Analog Scale (VAS) for 24 h. Analgesics were required during this period and the presence of shoulder pain was also noted. Results: Patients in the hydrocortisone group had lower pain scores (2.17 ± 0.47) compared to the bupivacaine group (3.51 ± 1.10). This difference in the mean VAS score was statistically significant (P < 0.01). Similarly, patients requiring rescue analgesia were 60.86% in Group B and 39.14% in Group H and were statistically significant. Time for rescue analgesia was longer in Group H as compared to Group B. Conclusion: Intraperitoneal bupivacaine and hydrocortisone decrease pain and analgesic requirements more effectively than bupivacaine alone after laparoscopic cholecystectomy without causing significant adverse effects.
{"title":"Intraperitoneal instillation of bupivacaine and hydrocortisone for postoperative analgesia in laparoscopic cholecystectomy under spinal anaesthesia – A prospective randomized study","authors":"Rajabhau Kshirsagar, S. Kuttarmare, P. Bhalerao, Sujit Kshirsagar","doi":"10.4103/ijpn.ijpn_88_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_88_22","url":null,"abstract":"Background: Laparoscopic cholecystectomy is a minimally invasive procedure requiring less hospital stay and early mobilization as compared to open procedure. The aim of our study was to compare the efficacy of intraperitoneal instillation of hydrocortisone with bupivacaine for postoperative analgesia in patients undergoing laparoscopic cholecystectomy under spinal anesthesia. Materials and Methods: Sixty patients were enrolled in this prospective randomized study. Patients either received 0.125% bupivacaine (Group B) or 0.125% bupivacaine with 100 mg hydrocortisone (Group H) through intraperitoneal drain at the end of surgery. Pain was evaluated every two hourly using the Visual Analog Scale (VAS) for 24 h. Analgesics were required during this period and the presence of shoulder pain was also noted. Results: Patients in the hydrocortisone group had lower pain scores (2.17 ± 0.47) compared to the bupivacaine group (3.51 ± 1.10). This difference in the mean VAS score was statistically significant (P < 0.01). Similarly, patients requiring rescue analgesia were 60.86% in Group B and 39.14% in Group H and were statistically significant. Time for rescue analgesia was longer in Group H as compared to Group B. Conclusion: Intraperitoneal bupivacaine and hydrocortisone decrease pain and analgesic requirements more effectively than bupivacaine alone after laparoscopic cholecystectomy without causing significant adverse effects.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"110 - 114"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43675687","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}
Priti Sherikar, Minna Osheen, M. Mitragotri, Arunima Gangadhar
Background: Preservative-free chloroprocaine (CP) 1% is being investigated for short surgeries but lacks immediate postoperative analgesia. Adding opioids to local anesthetic increases the quality of spinal anesthesia with prolongation of postoperative analgesia. Aim: The aim of this study is to compare the postoperative analgesic efficacy of intrathecal nalbuphine versus intrathecal fentanyl as an adjuvant to chlorprocaine 1% for short surgical lower limb procedures. Materials and Methods: After ethical committee approval, a prospective randomized double-blind comparative study was conducted on 90 patients of the American Society of Anesthesiologists classes 1 and 2, aged between 18 and 60 years who were scheduled for elective short surgical lower limb procedures. Group CP (n = 30) received CP 1% 40 mg (4 ml) plus saline (0.5 ml), Group CP with fentanyl (CF) (n = 30) received CP 1% 40 mg (4 ml) plus fentanyl 25 mcg (0.5 ml), and Group CP with nalbuphine (CN) (n = 30) received CP 1% 40 mg (4 ml) plus nalbuphine 0.8 mg (0.5 ml) intrathecally. After performing subarachnoid block, the parameters observed were – Onset, height, duration of sensory and motor blockade, duration of postoperative analgesia, hemodynamics, and adverse effects between the three groups noted. Results: The onset of sensory and motor block (min) is faster in Group CF (4.2 ± 0.2, 3.4 ± 0.4) compared to Group CN (4.8 ± 0.4, 3.7 ± 0.4) and Group CP (6.2 ± 0.4, 4 ± 0.4) (P < 0.001). The total sensory duration and motor duration are prolonged in Group CN (96.5 ± 5.2, 90 ± 3.9) compared to Group CF (94 ± 4, 87 ± 4.5) and Group CP (77 ± 3, 74 ± 4.5) (P < 0.001). The duration of postoperative analgesia was prolonged in Group CN (130 ± 5.3) compared to Group CF (111 ± 6.2) and Group C (93 ± 4.2) (P < 0.001). Conclusion: We conclude that intrathecal nalbuphine prolongs postoperative analgesia maximally compared to intrathecal fentanyl as an adjuvant to CP 1% for short surgical lower limb procedures.
{"title":"Comparison among intrathecal nalbuphine and fentanyl in combination with chloroprocaine 1% for short surgical lower limb procedures – A prospective randomized control trial","authors":"Priti Sherikar, Minna Osheen, M. Mitragotri, Arunima Gangadhar","doi":"10.4103/ijpn.ijpn_97_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_97_22","url":null,"abstract":"Background: Preservative-free chloroprocaine (CP) 1% is being investigated for short surgeries but lacks immediate postoperative analgesia. Adding opioids to local anesthetic increases the quality of spinal anesthesia with prolongation of postoperative analgesia. Aim: The aim of this study is to compare the postoperative analgesic efficacy of intrathecal nalbuphine versus intrathecal fentanyl as an adjuvant to chlorprocaine 1% for short surgical lower limb procedures. Materials and Methods: After ethical committee approval, a prospective randomized double-blind comparative study was conducted on 90 patients of the American Society of Anesthesiologists classes 1 and 2, aged between 18 and 60 years who were scheduled for elective short surgical lower limb procedures. Group CP (n = 30) received CP 1% 40 mg (4 ml) plus saline (0.5 ml), Group CP with fentanyl (CF) (n = 30) received CP 1% 40 mg (4 ml) plus fentanyl 25 mcg (0.5 ml), and Group CP with nalbuphine (CN) (n = 30) received CP 1% 40 mg (4 ml) plus nalbuphine 0.8 mg (0.5 ml) intrathecally. After performing subarachnoid block, the parameters observed were – Onset, height, duration of sensory and motor blockade, duration of postoperative analgesia, hemodynamics, and adverse effects between the three groups noted. Results: The onset of sensory and motor block (min) is faster in Group CF (4.2 ± 0.2, 3.4 ± 0.4) compared to Group CN (4.8 ± 0.4, 3.7 ± 0.4) and Group CP (6.2 ± 0.4, 4 ± 0.4) (P < 0.001). The total sensory duration and motor duration are prolonged in Group CN (96.5 ± 5.2, 90 ± 3.9) compared to Group CF (94 ± 4, 87 ± 4.5) and Group CP (77 ± 3, 74 ± 4.5) (P < 0.001). The duration of postoperative analgesia was prolonged in Group CN (130 ± 5.3) compared to Group CF (111 ± 6.2) and Group C (93 ± 4.2) (P < 0.001). Conclusion: We conclude that intrathecal nalbuphine prolongs postoperative analgesia maximally compared to intrathecal fentanyl as an adjuvant to CP 1% for short surgical lower limb procedures.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"115 - 119"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46528693","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}
{"title":"Aberrant branch of vertebral artery: A needling challenge for ultrasound-guided stellate ganglion block","authors":"P. Singh, D. Bhoi","doi":"10.4103/ijpn.ijpn_21_23","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_21_23","url":null,"abstract":"","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"136 - 137"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44392967","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}
{"title":"Pain education among government school children in West Bengal, India: A report","authors":"S. Goswami, G. Nandi, S. Basu","doi":"10.4103/ijpn.ijpn_76_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_76_22","url":null,"abstract":"","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"131 - 133"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47936777","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 : 2023-05-01DOI: 10.4103/ijpn.ijpn_128_22
V. Ahuja, D. Thapa, S. Mitra, Kushagrita Singh, Lekshmi V. Nair
Context: The unpredictable nature of COVID-19 pandemic and the limited patient–doctor interaction led to the change in chronic pain management during the pandemic. Aims: The study aimed to compare pain scores and bio-psycho-social aspects of chronic pain in patients during prepandemic versus COVID-19 pandemic period. Settings and Designs: This was a prospective, cross-sectional observational trial conducted in a tertiary care hospital. Subjects and Methods: The study was conducted between September 2021 and January 2022 which corresponded with the end of the second wave and beginning of the third wave of COVID-19 pandemic. A set of 20 web-based questionnaires were sent to adult patients of both genders and who had visited pain clinic before the onset of pandemic. Statistical Analysis Use: Discrete categorical data were presented as n (%); continuous data were written either in the form of its mean and standard deviation or in the form of its median and interquartile range. All statistical tests were two-sided and were performed at a significance level of P < 0.05. Results: A total of 408 patients of chronic pain participated in the web-based questionnaire. The most common diagnosis was low back pain, facial pain, and knee pain. The patients continued to consume analgesics during the pandemic, had ≥2 burnout score, and reported “poor to fair” quality of sleep score. During the pandemic, pain score increased in those subsets of patients who earlier had no pain (odds ratio [OR]: 68.33, confidence interval [CI]: 24.10–193.72, P = 0.000), mild pain (OR: 22.78, CI: 9.49–54.64, P = 0.000), and moderate pain. On the contrary, chronic pain decreased or remained same in the population having moderate or severe pain before the pandemic. Patients with increased pain during the pandemic wanted the outpatient department to reopen for consultation with pain physician. The majority of the patients 350 (85.78%) who had participated in the study did not suffer from COVID-19 infection. Conclusions: Regular intake of analgesics during the COVID-19 pandemic reduced the number of patients experiencing severe pain. However, the patients suffering from moderate-to-severe pain during the pandemic had a direct correlation between higher pain severity and poor quality of sleep.
{"title":"An analysis of patients with chronic pain amid COVID-19 pandemic: A cross-sectional observational trial","authors":"V. Ahuja, D. Thapa, S. Mitra, Kushagrita Singh, Lekshmi V. Nair","doi":"10.4103/ijpn.ijpn_128_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_128_22","url":null,"abstract":"Context: The unpredictable nature of COVID-19 pandemic and the limited patient–doctor interaction led to the change in chronic pain management during the pandemic. Aims: The study aimed to compare pain scores and bio-psycho-social aspects of chronic pain in patients during prepandemic versus COVID-19 pandemic period. Settings and Designs: This was a prospective, cross-sectional observational trial conducted in a tertiary care hospital. Subjects and Methods: The study was conducted between September 2021 and January 2022 which corresponded with the end of the second wave and beginning of the third wave of COVID-19 pandemic. A set of 20 web-based questionnaires were sent to adult patients of both genders and who had visited pain clinic before the onset of pandemic. Statistical Analysis Use: Discrete categorical data were presented as n (%); continuous data were written either in the form of its mean and standard deviation or in the form of its median and interquartile range. All statistical tests were two-sided and were performed at a significance level of P < 0.05. Results: A total of 408 patients of chronic pain participated in the web-based questionnaire. The most common diagnosis was low back pain, facial pain, and knee pain. The patients continued to consume analgesics during the pandemic, had ≥2 burnout score, and reported “poor to fair” quality of sleep score. During the pandemic, pain score increased in those subsets of patients who earlier had no pain (odds ratio [OR]: 68.33, confidence interval [CI]: 24.10–193.72, P = 0.000), mild pain (OR: 22.78, CI: 9.49–54.64, P = 0.000), and moderate pain. On the contrary, chronic pain decreased or remained same in the population having moderate or severe pain before the pandemic. Patients with increased pain during the pandemic wanted the outpatient department to reopen for consultation with pain physician. The majority of the patients 350 (85.78%) who had participated in the study did not suffer from COVID-19 infection. Conclusions: Regular intake of analgesics during the COVID-19 pandemic reduced the number of patients experiencing severe pain. However, the patients suffering from moderate-to-severe pain during the pandemic had a direct correlation between higher pain severity and poor quality of sleep.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"91 - 105"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45535840","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}
Interventional management of pain has been described as the 4th step of the WHO analgesic ladder and proves immensely useful for many refractory and resistant pains. Recurrent urinary tract infection (UTI) can lead to chronic pelvic and perineal pain, which are often refractory to analgesics including strong opioids, and requires centrally acting neuropathic pain medications, along with psychological and behavioral therapies, and may need interventional pain management. Sympathetic nerve blocks are indicated and can be used in management of visceral pain/cancer pain. A patient with cancer may experience pain due to cancer, side effects of its treatment, or a noncancer pathology. They are prone to recurrent infections including urinary tract, respiratory tract, bloodstream infections, among others, which become a common cause of morbidity and mortality in patients with cancer. In this case report, the authors present a case with advanced cancer in whom recurrent UTI led to chronic debilitating perineal pain which was successfully managed with superior hypogastric plexus and ganglion impar block highlighting the potential utility of these underutilized blocks in challenging situations of complex pelvic and perineal pains.
{"title":"Sympathetic blocks for the treatment of chronic pelvic/perineal pain secondary to recurrent urinary tract infection","authors":"M. Pruthi, G. Chanana, Meenu Walia","doi":"10.4103/ijpn.ijpn_60_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_60_22","url":null,"abstract":"Interventional management of pain has been described as the 4th step of the WHO analgesic ladder and proves immensely useful for many refractory and resistant pains. Recurrent urinary tract infection (UTI) can lead to chronic pelvic and perineal pain, which are often refractory to analgesics including strong opioids, and requires centrally acting neuropathic pain medications, along with psychological and behavioral therapies, and may need interventional pain management. Sympathetic nerve blocks are indicated and can be used in management of visceral pain/cancer pain. A patient with cancer may experience pain due to cancer, side effects of its treatment, or a noncancer pathology. They are prone to recurrent infections including urinary tract, respiratory tract, bloodstream infections, among others, which become a common cause of morbidity and mortality in patients with cancer. In this case report, the authors present a case with advanced cancer in whom recurrent UTI led to chronic debilitating perineal pain which was successfully managed with superior hypogastric plexus and ganglion impar block highlighting the potential utility of these underutilized blocks in challenging situations of complex pelvic and perineal pains.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"123 - 127"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43701075","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}
Swati Saroha, Dipasri Bhattacharya, P. Arya, Arpita Choudhury, Rajasree Biswas
Background: Pain originating in the facet joint accounts for an estimated 15%–45% of cases of low back pain. Radiofrequency ablation (RFA) of the medial branch nerves (MBN) is used in refractory cases. However, very few studies have compared the clinical outcomes of cooled versus conventional/traditional RFA (T-RFA) for the treatment of lumbar facet joint pain. Objective: To determine the clinical outcomes of MBN cooled RFA (C-RFA) compared with T-RFA, as measured by improvements in pain and physical function. Methodology: Forty patients with positive diagnostic MBN blocks were allocated to C-RFA or T-RFA group. Reduction in pain (NRS “Numerical Rating Scale” score), improvement in quality of life (Oswestry Disability Index [ODI]), proportion of responders/successful treatment (≥50% NRS reduction, and or ≥30% or ≥15 point reduction in ODI at 6 months follow up) in the two groups were recorded. Results: Total 34 patients were analysed, C-RFA (n = 18) and T-RFA (n = 16). There was significant reduction in pain scores as well as improvement in quality of life in both the groups, but the difference between the two groups was not significant. NRS reduction of ≥50% was observed in 72.22% and 68.5% of participants in the C-RFA and T-RFA groups, respectively (P = 0.824). A ≥15-point or ≥30% reduction in ODI score was observed in 77.77% and 75% of participants in the C-RFA and T-RFA groups, respectively (P = 0.849). Conclusions: Both the groups showed significant improvement in pain scores and quality of life. C-RFA resulted in greater treatment success rate than conventional RFA, but the difference was not significant.
{"title":"Two-arm observational study to assess the efficacy of cooled versus conventional radiofrequency ablation of medial branch nerves in patients with lumbar facet joint arthropathy","authors":"Swati Saroha, Dipasri Bhattacharya, P. Arya, Arpita Choudhury, Rajasree Biswas","doi":"10.4103/ijpn.ijpn_13_23","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_13_23","url":null,"abstract":"Background: Pain originating in the facet joint accounts for an estimated 15%–45% of cases of low back pain. Radiofrequency ablation (RFA) of the medial branch nerves (MBN) is used in refractory cases. However, very few studies have compared the clinical outcomes of cooled versus conventional/traditional RFA (T-RFA) for the treatment of lumbar facet joint pain. Objective: To determine the clinical outcomes of MBN cooled RFA (C-RFA) compared with T-RFA, as measured by improvements in pain and physical function. Methodology: Forty patients with positive diagnostic MBN blocks were allocated to C-RFA or T-RFA group. Reduction in pain (NRS “Numerical Rating Scale” score), improvement in quality of life (Oswestry Disability Index [ODI]), proportion of responders/successful treatment (≥50% NRS reduction, and or ≥30% or ≥15 point reduction in ODI at 6 months follow up) in the two groups were recorded. Results: Total 34 patients were analysed, C-RFA (n = 18) and T-RFA (n = 16). There was significant reduction in pain scores as well as improvement in quality of life in both the groups, but the difference between the two groups was not significant. NRS reduction of ≥50% was observed in 72.22% and 68.5% of participants in the C-RFA and T-RFA groups, respectively (P = 0.824). A ≥15-point or ≥30% reduction in ODI score was observed in 77.77% and 75% of participants in the C-RFA and T-RFA groups, respectively (P = 0.849). Conclusions: Both the groups showed significant improvement in pain scores and quality of life. C-RFA resulted in greater treatment success rate than conventional RFA, but the difference was not significant.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"86 - 90"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46816661","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}
Cancer patients experience pain secondary to the disease process or due to treatment. Refractory cancer pain can present a clinical challenge for pain physicians, which significantly affects patients' quality of life and increases disability. Erector spinae plane (ESP) blocks have rapidly been used in both acute and chronic pain practice. However, the use of ESP block for cancer pain management remains unclear. Thus, we conducted this scoping review to perform a comprehensive overview of current evidence on ESP block for cancer pain management. We searched the PubMed and Google Scholar databases for relevant articles published between January 2016 and March 2023 using the keywords “erector spinae plane block,” “ESP block,” and “cancer pain”. After excluding duplicate and irrelevant articles, we included a total of 26 studies, which were case reports, case series, cohort studies, and randomized control trials. Both neurolytic and non-neurolytic ESP blocks were used for cancer pain. The ESP blocks were performed in all patients with severe pain (Visual Analog Score or Numerical Rating Scale >7) and the majority of cases had some degree of pain relief. None of the studies has reported any serious complications related to procedure or drug used. There was heterogeneity in the type of drug, volume, and concentration used for ESP block. A definitive conclusion regarding the efficacy and safety of ESP block in cancer pain management was not possible. The current literature suggests that the ESP block can be helpful in cancer pain management. However, caution must be exercised not to overestimate the safety of either neurolytic or non-neurolytic ESP block as 88% (n = 23) of included studies were either case reports or case series. Randomized controlled clinical trials are warranted to establish the efficacy and safety of ESP block in cancer pain management.s
{"title":"Erector spinae plane block for cancer pain – A scoping review of current evidence","authors":"Indubala Maurya, R. Saxena, R. Maurya","doi":"10.4103/ijpn.ijpn_54_23","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_54_23","url":null,"abstract":"Cancer patients experience pain secondary to the disease process or due to treatment. Refractory cancer pain can present a clinical challenge for pain physicians, which significantly affects patients' quality of life and increases disability. Erector spinae plane (ESP) blocks have rapidly been used in both acute and chronic pain practice. However, the use of ESP block for cancer pain management remains unclear. Thus, we conducted this scoping review to perform a comprehensive overview of current evidence on ESP block for cancer pain management. We searched the PubMed and Google Scholar databases for relevant articles published between January 2016 and March 2023 using the keywords “erector spinae plane block,” “ESP block,” and “cancer pain”. After excluding duplicate and irrelevant articles, we included a total of 26 studies, which were case reports, case series, cohort studies, and randomized control trials. Both neurolytic and non-neurolytic ESP blocks were used for cancer pain. The ESP blocks were performed in all patients with severe pain (Visual Analog Score or Numerical Rating Scale >7) and the majority of cases had some degree of pain relief. None of the studies has reported any serious complications related to procedure or drug used. There was heterogeneity in the type of drug, volume, and concentration used for ESP block. A definitive conclusion regarding the efficacy and safety of ESP block in cancer pain management was not possible. The current literature suggests that the ESP block can be helpful in cancer pain management. However, caution must be exercised not to overestimate the safety of either neurolytic or non-neurolytic ESP block as 88% (n = 23) of included studies were either case reports or case series. Randomized controlled clinical trials are warranted to establish the efficacy and safety of ESP block in cancer pain management.s","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"74 - 80"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48488278","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 : 2023-05-01DOI: 10.4103/ijpn.ijpn_101_21
Samiksha Khanuja, J. Agarwal, S. Hussain, K. Batt
Pain management in patients with acute pancreatitis (AP) is mostly dominated by intravenous opioids. Besides their side effects, opioids also prolong the intensive care unit stay of the patient. The ultrasound-guided erector spinae plane block (ESPB) is an established intervention for postoperative analgesia. It is now also being studied for providing pain relief in AP. A lower thoracic ESPB targets sympathetic nerve fibers in addition to the dorsal and ventral rami through local anesthetic spread to the paravertebral space to provide both visceral and somatic analgesia. It could be an effective adjuvant as a part of multimodal analgesia and may significantly reduce overall opioid usage. We describe a case of AP where significant pain relief was achieved after administering a single-shot ESPB.
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