Sujit Kshirsagar, Pallavi Butiyani, Adnanali Sarkar, Geetanjali Dangat, Lisa Prakash, G. Girishkumar, Prathmesh Raut
Context: The surgical plethysmographic index (SPI) has been introduced as a measure of the balance between nociception and anti-nociception. The SPI is proposed for the titration of intraoperative analgesic drugs during general anesthesia. Aims: This study aimed to compare the requirement of intraoperative analgesic consumption between SPI-guided analgesia and conventional analgesia practices, requirement of rescue analgesics and to study recovery time. Subjects and Methods: In this double-blind, randomized control study, 64 patients undergoing lumbar spine surgery were randomly divided into SPI-guided analgesia group (SPI) and conventional practice group (control). In the SPI group, patients received injection fentanyl bolus of 0.5 μg/kg whenever SPI value increased above 50. While in the conventional group, injection fentanyl 0.5 μg/kg was administered according to conventional clinical practice. Statistical Analysis Used: The statistical significance of difference of various categorical variables across two groups was tested using the Chi-square test. For assessing intergroup statistical significance of difference of various continuous measurements, independent sample t-test was used. Results: Intraoperative fentanyl requirement was 119.53 ± 16.48 μg in the conventional group and 142.97 ± 24.78 μg in SPI-guided group (P < 0.05). The difference was statistically significant. The mean recovery time in conventional group was 13.03 ± 1.03 min, and for SPI group, it was 13.53 ± 1.14 min (P > 0.05). Conclusions: We can conclude that SPI guidance may not always help in decreasing the dose of intraoperative opioid consumption. It should be used in combination with hemodynamic parameters. SPI guidance may not affect recovery time.
{"title":"Intraoperative analgesic requirement using surgical plethysmographic index guidance in lumbar spine surgeries: A comparative study","authors":"Sujit Kshirsagar, Pallavi Butiyani, Adnanali Sarkar, Geetanjali Dangat, Lisa Prakash, G. Girishkumar, Prathmesh Raut","doi":"10.4103/ijpn.ijpn_42_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_42_22","url":null,"abstract":"Context: The surgical plethysmographic index (SPI) has been introduced as a measure of the balance between nociception and anti-nociception. The SPI is proposed for the titration of intraoperative analgesic drugs during general anesthesia. Aims: This study aimed to compare the requirement of intraoperative analgesic consumption between SPI-guided analgesia and conventional analgesia practices, requirement of rescue analgesics and to study recovery time. Subjects and Methods: In this double-blind, randomized control study, 64 patients undergoing lumbar spine surgery were randomly divided into SPI-guided analgesia group (SPI) and conventional practice group (control). In the SPI group, patients received injection fentanyl bolus of 0.5 μg/kg whenever SPI value increased above 50. While in the conventional group, injection fentanyl 0.5 μg/kg was administered according to conventional clinical practice. Statistical Analysis Used: The statistical significance of difference of various categorical variables across two groups was tested using the Chi-square test. For assessing intergroup statistical significance of difference of various continuous measurements, independent sample t-test was used. Results: Intraoperative fentanyl requirement was 119.53 ± 16.48 μg in the conventional group and 142.97 ± 24.78 μg in SPI-guided group (P < 0.05). The difference was statistically significant. The mean recovery time in conventional group was 13.03 ± 1.03 min, and for SPI group, it was 13.53 ± 1.14 min (P > 0.05). Conclusions: We can conclude that SPI guidance may not always help in decreasing the dose of intraoperative opioid consumption. It should be used in combination with hemodynamic parameters. SPI guidance may not affect recovery time.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"81 - 85"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44553271","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":"Morphological alterations in needle tip following trigger point dry needling","authors":"Manoj Sharma, Hardika Sood","doi":"10.4103/ijpn.ijpn_49_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_49_22","url":null,"abstract":"","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"134 - 135"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44877668","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":"Unveiling the power of perception: The placebo and nocebo effects in pain medicine research","authors":"Prateek Arora, Samarjit Dey","doi":"10.4103/ijpn.ijpn_59_23","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_59_23","url":null,"abstract":"","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"63 - 64"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44698575","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_115_22
Rituja Tambe, Preeti P Doshi
As the incidence of extensively drug-resistant tuberculosis is increasing, more cases of linezolid-induced peripheral neuropathy are being noted. It is challenging to treat. In this case report, we describe the successful management of this painful neuropathy using a multimodal multidisciplinary approach.
{"title":"Management of linezolid-induced peripheral neuropathy","authors":"Rituja Tambe, Preeti P Doshi","doi":"10.4103/ijpn.ijpn_115_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_115_22","url":null,"abstract":"As the incidence of extensively drug-resistant tuberculosis is increasing, more cases of linezolid-induced peripheral neuropathy are being noted. It is challenging to treat. In this case report, we describe the successful management of this painful neuropathy using a multimodal multidisciplinary approach.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"120 - 122"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42896712","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}
Arinze George Nwosu, L. Chukwu, O. Onwuasoigwe, S. Nweze, Kenneth I. Nwadike
Conventional analgesics have traditionally been the mainstay of pain management, but unsatisfactory pain relief and troubling side effects have led to continuing search for more efficacious and safer remedies. Adjuvant analgesics are drugs with beneficial analgesic effects despite not having been developed as analgesics. Adjuvants facilitate better pain control with a reduction in analgesic consumption, as well as the concomitant side effects. The opioid epidemic, deaths from opioid overdose, and several other complications of opioid-based analgesia have led to increasing interrogation of its use in both acute and chronic pain settings. The current trends in surgical practice, especially ambulatory surgery and enhanced recovery after surgery/fast-track care pathways have profoundly impacted the choices for acute pain management, with an increasing role for adjuvants. Medicinal cannabis and other adjuvants have also become increasingly popular for the management of intractable chronic pain and neuropathic pain owing to the inadequacy of conventional analgesics in these pain states. As clinical and research interest in patient safety and patient satisfaction evolve further development of adjuvant analgesics will be expected to fill the existing gaps in pain management. This review aims to examine the expanding role of analgesic adjuvants in the management of acute and chronic pains, and in the prevention of the transition to chronic pain. In doing so, we conducted an online search primarily on the PUBMED database using the term “analgesic adjuvant” for human studies published in peer-reviewed journals from 2000 to 2022.
{"title":"Redefining the role of analgesic adjuvants in pain management: A narrative review","authors":"Arinze George Nwosu, L. Chukwu, O. Onwuasoigwe, S. Nweze, Kenneth I. Nwadike","doi":"10.4103/ijpn.ijpn_23_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_23_22","url":null,"abstract":"Conventional analgesics have traditionally been the mainstay of pain management, but unsatisfactory pain relief and troubling side effects have led to continuing search for more efficacious and safer remedies. Adjuvant analgesics are drugs with beneficial analgesic effects despite not having been developed as analgesics. Adjuvants facilitate better pain control with a reduction in analgesic consumption, as well as the concomitant side effects. The opioid epidemic, deaths from opioid overdose, and several other complications of opioid-based analgesia have led to increasing interrogation of its use in both acute and chronic pain settings. The current trends in surgical practice, especially ambulatory surgery and enhanced recovery after surgery/fast-track care pathways have profoundly impacted the choices for acute pain management, with an increasing role for adjuvants. Medicinal cannabis and other adjuvants have also become increasingly popular for the management of intractable chronic pain and neuropathic pain owing to the inadequacy of conventional analgesics in these pain states. As clinical and research interest in patient safety and patient satisfaction evolve further development of adjuvant analgesics will be expected to fill the existing gaps in pain management. This review aims to examine the expanding role of analgesic adjuvants in the management of acute and chronic pains, and in the prevention of the transition to chronic pain. In doing so, we conducted an online search primarily on the PUBMED database using the term “analgesic adjuvant” for human studies published in peer-reviewed journals from 2000 to 2022.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"65 - 73"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70764341","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}
Objectives: Complex regional pain syndrome (CRPS), which usually develops after a traumatic event, often has a debilitating effect on the quality of life. Treatment is multidisciplinary and is based primarily on pain relief. Due to the symptoms of hyperalgesia and allodynia in patients with CRPS, dermatology opinion is often seeked. CRPS is a difficult disorder to treat and platelet-rich plasma (PRP) is a potential treatment modality for pain relief in this debilitating illness. We aimed to investigate the role of subcutaneous PRP for relief of hyperalgesia in patients with CRPS. Materials and Methods: A comparative prospective study of 15 male patients with CRPS diagnosed clinically by the Budapest criteria and radiologically by magnetic resonance imaging was enrolled for the study. PRP was injected subcutaneously at biweekly interval for 8 weeks and the results were assessed clinically by neuropathic pain score (NPS) score. The patient satisfaction was noted at baseline, 4 weeks, and 8 weeks. Patients were followed up for 3 months to assess the increase or decrease in hyperalgesia after stopping PRP. ANOVA was used with the Bonferroni correction for NPS score at various time interval. P ≤ 0.05 is considered statistically significant. Results: Numeric Rating Scale score showed statistically significant improvement at end of the study as compared to the baseline. Patients also had improvement in range of motion which was assessed at every visit. A few patients had mild redness and burning postprocedure which resolved spontaneously after a few hours. Conclusions: From this study, we concluded that subcutaneous PRP shows a significant reduction of hyperalgesia associated with CRPS.
{"title":"Subcutaneous platelet rich plasma therapy for management of hyperalgesia in complex regional pain syndrome","authors":"Aradhana Rout, Kamparsh Thakur, A. Choubey","doi":"10.4103/ijpn.ijpn_93_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_93_22","url":null,"abstract":"Objectives: Complex regional pain syndrome (CRPS), which usually develops after a traumatic event, often has a debilitating effect on the quality of life. Treatment is multidisciplinary and is based primarily on pain relief. Due to the symptoms of hyperalgesia and allodynia in patients with CRPS, dermatology opinion is often seeked. CRPS is a difficult disorder to treat and platelet-rich plasma (PRP) is a potential treatment modality for pain relief in this debilitating illness. We aimed to investigate the role of subcutaneous PRP for relief of hyperalgesia in patients with CRPS. Materials and Methods: A comparative prospective study of 15 male patients with CRPS diagnosed clinically by the Budapest criteria and radiologically by magnetic resonance imaging was enrolled for the study. PRP was injected subcutaneously at biweekly interval for 8 weeks and the results were assessed clinically by neuropathic pain score (NPS) score. The patient satisfaction was noted at baseline, 4 weeks, and 8 weeks. Patients were followed up for 3 months to assess the increase or decrease in hyperalgesia after stopping PRP. ANOVA was used with the Bonferroni correction for NPS score at various time interval. P ≤ 0.05 is considered statistically significant. Results: Numeric Rating Scale score showed statistically significant improvement at end of the study as compared to the baseline. Patients also had improvement in range of motion which was assessed at every visit. A few patients had mild redness and burning postprocedure which resolved spontaneously after a few hours. Conclusions: From this study, we concluded that subcutaneous PRP shows a significant reduction of hyperalgesia associated with CRPS.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"106 - 109"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42269902","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}
Background: Postoperative pain is a common sequel of modified radical mastectomy (MRM) and, when left unrelieved may progress to chronic pain syndrome known as persistent pain after breast cancer surgery. With increased breast cancer survival seen in recent years, it has become increasingly important to recognize and implement the best modalities of pain-relieving treatment. Aims: The aim of the study was to compare the analgesic efficacy of ultrasound (US)-guided serratus anterior plane block (SAPB) and conventional anatomical landmark-guided thoracic paravertebral block (TPVB) for MRM in terms of time to first request for rescue analgesia and other associated characteristics in terms of time taken to perform both blocks (in minutes), intraoperative fentanyl consumption, Visual Analog Scale (VAS) score and morphine consumption on the 1st postoperative day, intraoperative and postoperative hemodynamics (heart rate and mean arterial pressure), and complications of either block techniques. Settings and Design: This study was conducted at a single-center tertiary care hospital in the form of parallel-group randomized controlled trial (RCT), which was based on computer-generated randomization. Materials and Methods: This RCT was conducted on 78 adult females posted for MRM. After intubation, patients were administered a single-shot injection of either TPVB at T4 (Group T, n = 39) or SAPB between the 4th and 5th ribs (Group S, n = 39) with 20 ml of 0.5% bupivacaine. Time to first rescue analgesic, morphine consumption in patient-controlled analgesia pump, VAS score, intraoperative hemodynamics, and adverse effects were recorded. Statistical Analyses: All raw data were entered into a Microsoft Excel spreadsheet and analyzed using the appropriate statistical methods using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA). Data were expressed in mean ± standard deviation (SD), and P < 0.05 was considered statistically significant. Data were summarized by routine descriptive statistics, namely mean and SD for numerical variables that are normally distributed, the median and interquartile range for skewed numerical variables, and counts and percentages for the categorical variables. Numerical variables were compared between the groups by Student's independent sample t-test, when normally distributed and by Mann–Whitney U-test when skewed. Results: The duration of analgesia was significantly longer in the TPVB group as compared to the SAPB group (7.77 ± 1.317 h vs. 6.59 ± 1.174 h, P < 0.05). The postoperative 24 h morphine consumption (mean ± SD) was also significantly higher in the SAPB group as compared to the TPVB group (7.03 ± 1.135 mg vs. 5.74 ± 1.21 mg, P < 0.05). Conclusion: Preincisional conventional anatomical landmark-guided TPVB is significantly superior to preincisional US-guided SAPB in terms of duration of analgesia and overall morphine consumption in post-MRM patients.
背景:术后疼痛是改良根治性乳房切除术(MRM)的常见后遗症，如果不缓解，可能会在乳腺癌手术后发展为慢性疼痛综合征，即持续性疼痛。随着近年来乳腺癌生存率的提高，认识和实施最佳的镇痛治疗方式变得越来越重要。目的:本研究的目的是比较超声(US)引导下锯肌前平面阻滞(SAPB)和传统解剖标志引导下胸椎旁阻滞(TPVB)在MRM中首次请求抢救镇痛的时间和其他相关特征，包括两种阻滞所需的时间(以分钟为单位)、术中芬太尼用量、视觉模拟量表(VAS)评分和术后第一天吗啡用量。术中和术后血流动力学(心率和平均动脉压)，以及两种阻滞技术的并发症。环境与设计:本研究在单中心三级医院进行，采用平行组随机对照试验(RCT)的形式，基于计算机生成随机化。材料与方法:本随机对照试验对78名成年女性进行磁共振成像。插管后，患者在T4处(T组，n = 39)或在第4和第5肋骨之间(S组，n = 39)单次注射TPVB和0.5%布比卡因20 ml。记录首次抢救镇痛时间、患者自控镇痛泵吗啡用量、VAS评分、术中血流动力学及不良反应。统计分析:所有原始数据输入到Microsoft Excel电子表格中，使用SPSS(27.0版本;SPSS Inc.，芝加哥，伊利诺伊州，美国)。数据以均数±标准差(SD)表示，以P < 0.05为差异有统计学意义。采用常规描述性统计方法对数据进行汇总，即正态分布的数值变量的均值和SD，偏态分布的数值变量的中位数和四分位数范围，分类变量的计数和百分比。正态分布时采用学生独立样本t检验，偏态分布时采用Mann-Whitney u检验。结果:TPVB组镇痛时间明显长于SAPB组(7.77±1.317 h∶6.59±1.174 h, P < 0.05)。SAPB组术后24 h吗啡用量(平均±SD)显著高于TPVB组(7.03±1.135 mg vs. 5.74±1.21 mg, P < 0.05)。结论:在mrm后患者中，术前常规解剖标志引导下的TPVB在镇痛持续时间和吗啡总用量方面明显优于术前us引导下的SAPB。
{"title":"A comparative study of analgesic efficacy of ultrasound-guided serratus anterior plane block versus landmark-guided thoracic paravertebral block for modified radical mastectomy under general anesthesia","authors":"Manshi Gandhi, Chiranjib Bhattacharyya, Soumik Mazumder, Basanta Gandhi","doi":"10.4103/ijpn.ijpn_36_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_36_22","url":null,"abstract":"Background: Postoperative pain is a common sequel of modified radical mastectomy (MRM) and, when left unrelieved may progress to chronic pain syndrome known as persistent pain after breast cancer surgery. With increased breast cancer survival seen in recent years, it has become increasingly important to recognize and implement the best modalities of pain-relieving treatment. Aims: The aim of the study was to compare the analgesic efficacy of ultrasound (US)-guided serratus anterior plane block (SAPB) and conventional anatomical landmark-guided thoracic paravertebral block (TPVB) for MRM in terms of time to first request for rescue analgesia and other associated characteristics in terms of time taken to perform both blocks (in minutes), intraoperative fentanyl consumption, Visual Analog Scale (VAS) score and morphine consumption on the 1st postoperative day, intraoperative and postoperative hemodynamics (heart rate and mean arterial pressure), and complications of either block techniques. Settings and Design: This study was conducted at a single-center tertiary care hospital in the form of parallel-group randomized controlled trial (RCT), which was based on computer-generated randomization. Materials and Methods: This RCT was conducted on 78 adult females posted for MRM. After intubation, patients were administered a single-shot injection of either TPVB at T4 (Group T, n = 39) or SAPB between the 4th and 5th ribs (Group S, n = 39) with 20 ml of 0.5% bupivacaine. Time to first rescue analgesic, morphine consumption in patient-controlled analgesia pump, VAS score, intraoperative hemodynamics, and adverse effects were recorded. Statistical Analyses: All raw data were entered into a Microsoft Excel spreadsheet and analyzed using the appropriate statistical methods using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA). Data were expressed in mean ± standard deviation (SD), and P < 0.05 was considered statistically significant. Data were summarized by routine descriptive statistics, namely mean and SD for numerical variables that are normally distributed, the median and interquartile range for skewed numerical variables, and counts and percentages for the categorical variables. Numerical variables were compared between the groups by Student's independent sample t-test, when normally distributed and by Mann–Whitney U-test when skewed. Results: The duration of analgesia was significantly longer in the TPVB group as compared to the SAPB group (7.77 ± 1.317 h vs. 6.59 ± 1.174 h, P < 0.05). The postoperative 24 h morphine consumption (mean ± SD) was also significantly higher in the SAPB group as compared to the TPVB group (7.03 ± 1.135 mg vs. 5.74 ± 1.21 mg, P < 0.05). Conclusion: Preincisional conventional anatomical landmark-guided TPVB is significantly superior to preincisional US-guided SAPB in terms of duration of analgesia and overall morphine consumption in post-MRM patients.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"34 - 40"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41807163","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":"Pilot study: Dipping your toe into the water","authors":"Indubala Maurya, A. Lohiya","doi":"10.4103/ijpn.ijpn_15_23","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_15_23","url":null,"abstract":"","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"1 - 2"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45104133","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 : 2023-01-01DOI: 10.4103/ijpn.ijpn_104_22
A. Chakravarty
Trigeminal Autonomic Cephalgia (TAC) refers to a group of disorders involving afferent activation of trigeminal system from the pain-perceiving intracranial structures. Short unilateral neuralgiform headache with conjunctival redness and tearing (SUNCT) is a sub-group of TAC which at times can be refractory to treatment. Percutaneous balloon compression (PBC) of the trigeminal ganglion is an established treatment modality for trigeminal neuralgia. However, PBC has been sparingly utilized for treatment of SUNCT. In this case report we intend to highlight good long-term results of PBC for treatment of refractory SUNCT.
{"title":"Percutaneous balloon compression of the trigeminal ganglion for refractory short-lasting unilateral neuralgiform headache with conjunctival redness and tearing syndrome","authors":"A. Chakravarty","doi":"10.4103/ijpn.ijpn_104_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_104_22","url":null,"abstract":"Trigeminal Autonomic Cephalgia (TAC) refers to a group of disorders involving afferent activation of trigeminal system from the pain-perceiving intracranial structures. Short unilateral neuralgiform headache with conjunctival redness and tearing (SUNCT) is a sub-group of TAC which at times can be refractory to treatment. Percutaneous balloon compression (PBC) of the trigeminal ganglion is an established treatment modality for trigeminal neuralgia. However, PBC has been sparingly utilized for treatment of SUNCT. In this case report we intend to highlight good long-term results of PBC for treatment of refractory SUNCT.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"50 - 52"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48346792","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}
Background: Pain is a common symptom in patients undergoing major mandibular surgeries and reconstruction. To date, no studies have been done to assess the severity of pain and its effect on the quality of life post this surgery. Aim: To assess pain severity in the perioperative period and its impact on quality of life in head-and-neck cancer patients undergoing major mandibular resection with reconstruction. Primary Objective: To assess pain severity in the first 7 days following surgery. Secondary Objective: To identify the proportion of patients who continue to have pain at 4-month postsurgery and its impact on quality of life. Design: Prospective observational study. Materials and Methods: This study was conducted in a tertiary care cancer center. Between February and June 2016, 51 head-and-neck cancer patients undergoing reconstructive surgery were enrolled in the study after written informed consent. The pain was assessed using an 11-point Numerical rating scale (NRS) preoperatively, at 7 days, 1- and 4-month postsurgery, and quality of life was assessed by brief pain inventory (BPI). Results: Moderate-to-severe pain was reported by 46 patients (90.2%) on the 1st day and 44 patients (86.3%) on the 2nd post-operative day, which reduced to 27 patients (52.9%) over the next 2 days. By day 5, 48 (94.1%) patients had mild pain. By 1 month, 39 patients (76.5%) had moderate pain. By 4 months, 49 patients (96.1%) had mild pain, while two patients (3.9%) had severe pain. Quality of life was maximally affected at the end of the 1st month in all patients. At 4 months, only 1 (2%) patient had the affection of quality of life. This patient had severe preoperative pain. Conclusion: In patients undergoing extensive resection and reconstruction, moderate-to-severe pain was noted not only in the immediate postoperative period, but up to 1-month postsurgery and affected their quality of life. Stringent perioperative analgesia guidelines are needed in managing such patients and improving their quality of life.
{"title":"Pain severity and quality of life following major mandibular reconstructive surgery in head neck cancer","authors":"Aparna Gotur, A. Chatterjee","doi":"10.4103/ijpn.ijpn_80_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_80_22","url":null,"abstract":"Background: Pain is a common symptom in patients undergoing major mandibular surgeries and reconstruction. To date, no studies have been done to assess the severity of pain and its effect on the quality of life post this surgery. Aim: To assess pain severity in the perioperative period and its impact on quality of life in head-and-neck cancer patients undergoing major mandibular resection with reconstruction. Primary Objective: To assess pain severity in the first 7 days following surgery. Secondary Objective: To identify the proportion of patients who continue to have pain at 4-month postsurgery and its impact on quality of life. Design: Prospective observational study. Materials and Methods: This study was conducted in a tertiary care cancer center. Between February and June 2016, 51 head-and-neck cancer patients undergoing reconstructive surgery were enrolled in the study after written informed consent. The pain was assessed using an 11-point Numerical rating scale (NRS) preoperatively, at 7 days, 1- and 4-month postsurgery, and quality of life was assessed by brief pain inventory (BPI). Results: Moderate-to-severe pain was reported by 46 patients (90.2%) on the 1st day and 44 patients (86.3%) on the 2nd post-operative day, which reduced to 27 patients (52.9%) over the next 2 days. By day 5, 48 (94.1%) patients had mild pain. By 1 month, 39 patients (76.5%) had moderate pain. By 4 months, 49 patients (96.1%) had mild pain, while two patients (3.9%) had severe pain. Quality of life was maximally affected at the end of the 1st month in all patients. At 4 months, only 1 (2%) patient had the affection of quality of life. This patient had severe preoperative pain. Conclusion: In patients undergoing extensive resection and reconstruction, moderate-to-severe pain was noted not only in the immediate postoperative period, but up to 1-month postsurgery and affected their quality of life. Stringent perioperative analgesia guidelines are needed in managing such patients and improving their quality of life.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"20 - 26"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49349096","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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