Sandeep Sharma, S. Choudhary, Vikram Bedi, Swathi Kalluraya
Background and Aims: Caudal block provides good perioperative analgesia for pediatric infraumbilical surgeries but has a short duration of action after a single injection. To overcome this limitation, we evaluated the effect of magnesium sulfate added to caudal bupivacaine on postoperative analgesia in pediatric patients undergoing infraumbilical surgeries. Materials and Methods: In this prospective randomized double-blind comparative study, 60 American Society of Anesthesiologists Grade I, II children aged 1–5 years, of either gender, undergoing infraumbilical elective surgeries were randomly divided into 2 Groups (Group M [Magnesium sulfate] and Group C [control]) and received caudal block with magnesium sulfate 50 mg (upto 1 ml with saline) and 1 ml saline, respectively, added to 1 ml/kg of 0.25% bupivacaine. Hemodynamic parameters were recorded at predefined time intervals. Postoperative pain by Face, Legs, Activity, Cry and Consolability (FLACC) scale and level of sedation by Ramsay Sedation Score was assessed postoperatively. Duration of analgesia and number of rescue analgesic doses received in 24 h were recorded. Quantitative and qualitative variables were analyzed using Mann–Whitney U test, Chi-Square test, and Kruskal–Wallis test where deemed appropriate. P ≤ 0.05 was considered statistically significant. Results: The mean duration of analgesia was significantly higher in Group M with reduced requirement of rescue analgesic doses. FLACC scores were higher in control Group C at all time intervals. Patients in the magnesium group were sedated for a longer period. Both groups had comparable hemodynamic parameters throughout the study. Conclusion: Magnesium sulfate as an adjuvant to bupivacaine in caudal block prolongs the duration of analgesia with a reduction of postoperative rescue analgesic requirement in pediatric patients.
{"title":"Evaluation of analgesic efficacy of magnesium sulfate as an adjuvant to caudal bupivacaine in pediatric infraumbilical surgeries – A prospective randomized double-blind study","authors":"Sandeep Sharma, S. Choudhary, Vikram Bedi, Swathi Kalluraya","doi":"10.4103/ijpn.ijpn_55_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_55_22","url":null,"abstract":"Background and Aims: Caudal block provides good perioperative analgesia for pediatric infraumbilical surgeries but has a short duration of action after a single injection. To overcome this limitation, we evaluated the effect of magnesium sulfate added to caudal bupivacaine on postoperative analgesia in pediatric patients undergoing infraumbilical surgeries. Materials and Methods: In this prospective randomized double-blind comparative study, 60 American Society of Anesthesiologists Grade I, II children aged 1–5 years, of either gender, undergoing infraumbilical elective surgeries were randomly divided into 2 Groups (Group M [Magnesium sulfate] and Group C [control]) and received caudal block with magnesium sulfate 50 mg (upto 1 ml with saline) and 1 ml saline, respectively, added to 1 ml/kg of 0.25% bupivacaine. Hemodynamic parameters were recorded at predefined time intervals. Postoperative pain by Face, Legs, Activity, Cry and Consolability (FLACC) scale and level of sedation by Ramsay Sedation Score was assessed postoperatively. Duration of analgesia and number of rescue analgesic doses received in 24 h were recorded. Quantitative and qualitative variables were analyzed using Mann–Whitney U test, Chi-Square test, and Kruskal–Wallis test where deemed appropriate. P ≤ 0.05 was considered statistically significant. Results: The mean duration of analgesia was significantly higher in Group M with reduced requirement of rescue analgesic doses. FLACC scores were higher in control Group C at all time intervals. Patients in the magnesium group were sedated for a longer period. Both groups had comparable hemodynamic parameters throughout the study. Conclusion: Magnesium sulfate as an adjuvant to bupivacaine in caudal block prolongs the duration of analgesia with a reduction of postoperative rescue analgesic requirement in pediatric patients.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"41 - 46"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46051298","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}
This case series assesses the benefits of intracutaneous injection of botulinum toxin A (BTX-A) for the treatment of intractable pain of supraorbital postherpetic neuralgia (PHN) not responding to oral drug therapy. Three patients experiencing intractable pain of supraorbital PHN, which was not responding satisfactorily to oral pregabalin and oral amitriptyline therapy, were managed with the intracutaneous injection of BTX-A in the affected dermatomes. Postinjection during each visit at 2, 4, 6, 8, 10, and 16 weeks, the Numeric Rating Scale pain score of the patients was assessed (0: painless; 10: maximum pain). There was a significant reduction in the severity of pain after BTX-A injection, and subsequently, the oral medications were significantly reduced thereafter. Hence, BTX significantly decreases the severity of intractable pain in supraorbital PHN patients.
{"title":"Botulinum toxin A for refractory neuropathic pain in supraorbital postherpetic neuralgia","authors":"A. Saxena, Sumana Choudhary, A. Saxena","doi":"10.4103/ijpn.ijpn_65_21","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_65_21","url":null,"abstract":"This case series assesses the benefits of intracutaneous injection of botulinum toxin A (BTX-A) for the treatment of intractable pain of supraorbital postherpetic neuralgia (PHN) not responding to oral drug therapy. Three patients experiencing intractable pain of supraorbital PHN, which was not responding satisfactorily to oral pregabalin and oral amitriptyline therapy, were managed with the intracutaneous injection of BTX-A in the affected dermatomes. Postinjection during each visit at 2, 4, 6, 8, 10, and 16 weeks, the Numeric Rating Scale pain score of the patients was assessed (0: painless; 10: maximum pain). There was a significant reduction in the severity of pain after BTX-A injection, and subsequently, the oral medications were significantly reduced thereafter. Hence, BTX significantly decreases the severity of intractable pain in supraorbital PHN patients.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"47 - 49"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42698822","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_110_22
Sunny Malik, Naina Kumar, S. Joshi
{"title":"See the unseen – Neoangiogenesis in cancer","authors":"Sunny Malik, Naina Kumar, S. Joshi","doi":"10.4103/ijpn.ijpn_110_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_110_22","url":null,"abstract":"","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"61 - 62"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43700777","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}
Gegal Pruthi, Mayank Gupta, K. Bharathi, Nidhi Singh, D. Sood, Karamjot Singh, Praveen Choudhary, Priyanka Gupta
Background: Ilioinguinal and iliohypogastric (IIIH) nerve block for postoperative analgesia after lower-segment cesarean section (LSCS) is stated to have a short duration of action, and prolongation of its effect with adjuvants remains unexplored. We aimed to assess the efficacy of dexamethasone and fentanyl as adjuvants to ropivacaine in ultrasound-guided bilateral IIIH block. Methods: After approval from the Institutional Ethics Committee and informed consent, this prospective randomized double-blind study enrolled 40 American Society of Anesthesiologists II parturients, divided into two groups. Group I (n = 20) received IIIH block with 3 mg/kg of 0.75% ropivacaine and dexamethasone 8 mg whereas Group II (n = 20) received 3 mg/kg of 0.75% ropivacaine and fentanyl 50 μg. The primary outcome studied was the duration of analgesia (as defined by the requirement of first rescue analgesia). The secondary outcomes included total rescue analgesic consumption and the median number of times rescue analgesic requirement in 24 h postoperatively. Student's t-test and Mann–Whitney U-test were applied to compare the analgesic parameters among the groups. Results: Both the groups were comparable for the duration of analgesia (8.15 ± 0.95 vs. 7.55 ± 1.51 h, P = 0.142), the median number of times rescue analgesics required in 24 h (2.5 [2–3] in Group I vs. 3 [2–3] in Group II, P = 0.590), and total tramadol required in 24 h (125 ± 25.6 vs. 130 ± 25.1 mg, P = 0.540). Conclusion: Both dexamethasone and fentanyl as an adjuvant to ropivacaine for IIIH block were found to have a comparable duration of analgesia following LSCS.
{"title":"Dexamethasone versus fentanyl as an adjuvant to ropivacaine in ilioinguinal and iliohypogastric nerve block for postoperative analgesia: A prospective randomized double-blind trial in lower-segment cesarean section","authors":"Gegal Pruthi, Mayank Gupta, K. Bharathi, Nidhi Singh, D. Sood, Karamjot Singh, Praveen Choudhary, Priyanka Gupta","doi":"10.4103/ijpn.ijpn_21_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_21_22","url":null,"abstract":"Background: Ilioinguinal and iliohypogastric (IIIH) nerve block for postoperative analgesia after lower-segment cesarean section (LSCS) is stated to have a short duration of action, and prolongation of its effect with adjuvants remains unexplored. We aimed to assess the efficacy of dexamethasone and fentanyl as adjuvants to ropivacaine in ultrasound-guided bilateral IIIH block. Methods: After approval from the Institutional Ethics Committee and informed consent, this prospective randomized double-blind study enrolled 40 American Society of Anesthesiologists II parturients, divided into two groups. Group I (n = 20) received IIIH block with 3 mg/kg of 0.75% ropivacaine and dexamethasone 8 mg whereas Group II (n = 20) received 3 mg/kg of 0.75% ropivacaine and fentanyl 50 μg. The primary outcome studied was the duration of analgesia (as defined by the requirement of first rescue analgesia). The secondary outcomes included total rescue analgesic consumption and the median number of times rescue analgesic requirement in 24 h postoperatively. Student's t-test and Mann–Whitney U-test were applied to compare the analgesic parameters among the groups. Results: Both the groups were comparable for the duration of analgesia (8.15 ± 0.95 vs. 7.55 ± 1.51 h, P = 0.142), the median number of times rescue analgesics required in 24 h (2.5 [2–3] in Group I vs. 3 [2–3] in Group II, P = 0.590), and total tramadol required in 24 h (125 ± 25.6 vs. 130 ± 25.1 mg, P = 0.540). Conclusion: Both dexamethasone and fentanyl as an adjuvant to ropivacaine for IIIH block were found to have a comparable duration of analgesia following LSCS.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"27 - 33"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47770796","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}
Samir Basak, K. Poddar, Suryabrata Chattopadhyay, C. Pal
Background: Osteoarthritis (OA) of the knee is the most frequent progressive degenerative joint disease with a 20% prevalence in India. Many patients with knee OA elect to avoid surgery, and others are poor surgical candidates due to medical comorbidities. Aims: This study aimed to determine 3-, 6-, and 12-month clinical outcomes of genicular nerve cooled radiofrequency ablation (CRFA) for the treatment of chronic pain due to primary knee OA. Study Settings and Design: The present study, a single-armed prospective observational study, was conducted in a tertiary care hospital between March 2020 and December 2021. The genicular nerve CRFA treatments were performed in chronic knee OA patients with a radiological grade of 2 (mild), 3 (moderate), or 4 (severe) (Kellgren and Lawrence system) not responding to conservative therapies for at least 6 months. A total of 70 patients were enrolled in the study. Out of this, 62 patients were finally analyzed for the study. Methods: All the patients received procedural sedation and were placed in the supine position on the operating table. Fluoroscopy-guided CRF genicular nerve ablation was performed using anatomic landmarks at superior lateral, superior medial, and inferior medial sites. Further needle position was confirmed by motor and sensory stimulation. Each target was sequentially lesioned for 2 min and 30 s at a set temperature of 60°C. The average procedure duration was 40 min for the index knee. The patient was discharged on the same day. All patients were followed up in person after 3, 6, and 12 months. Patients answered the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire (96 points) and Numeric Rating Scale (NRS) pain score (0 – no pain and 10 – maximum pain) before the procedure and during each follow-up after treatment. Statistical Analysis: Results were analyzed using Pearson's Chi-square test, Fisher's exact test, and ANOVA as appropriate. P >0.05 was considered statistically significant. Results: The average mean baseline pain score was 9.00 (8.41 ± 0.66) and the mean WOMAC score was 80.00 (80.02 ± 6.92). The pain score (NRS) and WOMAC score at 3-, 6-, and 12-month intervals after postprocedure follow-up were reduced significantly from the baseline level (P < 0.001). Total 91.93% (57/62) of the patients successfully responded (≥50% improvement from the baseline was a good response) to the treatment according to NRS pain score during 3- and 6-month follow-up visits. Then, it was reduced to 77.41% (48/62) during 12 months of follow-up visits. Similarly, the average median WOMAC score was reduced to 25.00 (28.80 ± 10.82), 25.00 (29.35 ± 11.12), and 34.00 (34.96 ± 11.28) during a subsequent follow-up visit at 3, 6, and 12 months. Hence, the response to the cooled radiofrequency treatment was good (≥50% improvement) throughout the study period of 12 months according to the NRS pain score and the global subjective improvement score (WOMAC score). There were a few
{"title":"Long-term pain relief after genicular nerve cooled radiofrequency ablation in chronic knee osteoarthritis – A prospective observational case study","authors":"Samir Basak, K. Poddar, Suryabrata Chattopadhyay, C. Pal","doi":"10.4103/ijpn.ijpn_48_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_48_22","url":null,"abstract":"Background: Osteoarthritis (OA) of the knee is the most frequent progressive degenerative joint disease with a 20% prevalence in India. Many patients with knee OA elect to avoid surgery, and others are poor surgical candidates due to medical comorbidities. Aims: This study aimed to determine 3-, 6-, and 12-month clinical outcomes of genicular nerve cooled radiofrequency ablation (CRFA) for the treatment of chronic pain due to primary knee OA. Study Settings and Design: The present study, a single-armed prospective observational study, was conducted in a tertiary care hospital between March 2020 and December 2021. The genicular nerve CRFA treatments were performed in chronic knee OA patients with a radiological grade of 2 (mild), 3 (moderate), or 4 (severe) (Kellgren and Lawrence system) not responding to conservative therapies for at least 6 months. A total of 70 patients were enrolled in the study. Out of this, 62 patients were finally analyzed for the study. Methods: All the patients received procedural sedation and were placed in the supine position on the operating table. Fluoroscopy-guided CRF genicular nerve ablation was performed using anatomic landmarks at superior lateral, superior medial, and inferior medial sites. Further needle position was confirmed by motor and sensory stimulation. Each target was sequentially lesioned for 2 min and 30 s at a set temperature of 60°C. The average procedure duration was 40 min for the index knee. The patient was discharged on the same day. All patients were followed up in person after 3, 6, and 12 months. Patients answered the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire (96 points) and Numeric Rating Scale (NRS) pain score (0 – no pain and 10 – maximum pain) before the procedure and during each follow-up after treatment. Statistical Analysis: Results were analyzed using Pearson's Chi-square test, Fisher's exact test, and ANOVA as appropriate. P >0.05 was considered statistically significant. Results: The average mean baseline pain score was 9.00 (8.41 ± 0.66) and the mean WOMAC score was 80.00 (80.02 ± 6.92). The pain score (NRS) and WOMAC score at 3-, 6-, and 12-month intervals after postprocedure follow-up were reduced significantly from the baseline level (P < 0.001). Total 91.93% (57/62) of the patients successfully responded (≥50% improvement from the baseline was a good response) to the treatment according to NRS pain score during 3- and 6-month follow-up visits. Then, it was reduced to 77.41% (48/62) during 12 months of follow-up visits. Similarly, the average median WOMAC score was reduced to 25.00 (28.80 ± 10.82), 25.00 (29.35 ± 11.12), and 34.00 (34.96 ± 11.28) during a subsequent follow-up visit at 3, 6, and 12 months. Hence, the response to the cooled radiofrequency treatment was good (≥50% improvement) throughout the study period of 12 months according to the NRS pain score and the global subjective improvement score (WOMAC score). There were a few","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"13 - 19"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43760540","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}
Madhuri Lokapur, Nand Kumar, Hemang Shah, Dhara Shah
Chronic pain and psychiatric conditions often coexist with shared risk factors and a reverse causal link. Depression and anxiety comorbidities are associated with increased pain intensity, less favorable response to treatments, and higher medical costs. The management of psychiatric comorbidities in chronic pain conditions is less explored in India. This paper aims to review the current literature landscape of comorbid depressive and/or anxiety disorders with chronic pain conditions in the Indian populations and identify need gaps for future research. A literature search on MEDLINE database and other sources conducted from January 2010 through March 2020 retrieved 84 shortlisted eligible articles and their findings were synthesized into a narrative review. There was a high prevalence of comorbid depression and anxiety with chronic pain observed across multiple pain etiologies and population groups in the Indian setting. Women had a higher burden of psychiatric comorbidities in chronic pain conditions compared with men. Poor socioeconomic conditions and pain severity were important risk factors that predisposed individuals to psychological distress. There was limited data on evidence-based management of chronic pain and comorbid depression or anxiety for Indian populations. Barriers toward effective pain management in India occur at the level of patients, physicians, or healthcare systems; some of these challenges relate to patient's health-seeking behavior, stigma associated with psychiatric treatment, physician awareness, and education, and access to pain medications. Future initiatives are needed toward building an evidence base for effective management of pain and comorbid psychiatric conditions in India.
{"title":"A review of chronic pain with depression and/or anxiety comorbidities in the Indian population","authors":"Madhuri Lokapur, Nand Kumar, Hemang Shah, Dhara Shah","doi":"10.4103/ijpn.ijpn_26_21","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_26_21","url":null,"abstract":"Chronic pain and psychiatric conditions often coexist with shared risk factors and a reverse causal link. Depression and anxiety comorbidities are associated with increased pain intensity, less favorable response to treatments, and higher medical costs. The management of psychiatric comorbidities in chronic pain conditions is less explored in India. This paper aims to review the current literature landscape of comorbid depressive and/or anxiety disorders with chronic pain conditions in the Indian populations and identify need gaps for future research. A literature search on MEDLINE database and other sources conducted from January 2010 through March 2020 retrieved 84 shortlisted eligible articles and their findings were synthesized into a narrative review. There was a high prevalence of comorbid depression and anxiety with chronic pain observed across multiple pain etiologies and population groups in the Indian setting. Women had a higher burden of psychiatric comorbidities in chronic pain conditions compared with men. Poor socioeconomic conditions and pain severity were important risk factors that predisposed individuals to psychological distress. There was limited data on evidence-based management of chronic pain and comorbid depression or anxiety for Indian populations. Barriers toward effective pain management in India occur at the level of patients, physicians, or healthcare systems; some of these challenges relate to patient's health-seeking behavior, stigma associated with psychiatric treatment, physician awareness, and education, and access to pain medications. Future initiatives are needed toward building an evidence base for effective management of pain and comorbid psychiatric conditions in India.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"3 - 12"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42893482","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}
Neuropathic pain is associated with hyperalgesia, allodynia, and other paresthesia affecting the sleep, social, personal, and emotional life of a person. Numerous causes have been described for neuropathic pain. Nutritional deficiency is one uncommon cause. In this case report, we present a 27-year-old female patient who came to the pain clinic with severe burning pain, pricking sensation, and increased sensitivity to touch and pain for the past 2 months. The patient was diagnosed with thiamine deficiency and started on nutritional replacement therapy. A multidisciplinary approach involving drugs, physiotherapy along with replacement therapy was started, following which the patient started showing improvement in the symptoms.
{"title":"Dry beriberi at the pain clinic – B1 deficiency neuropathic pain post gastric bypass","authors":"M. Priyanka, K. Khan, M. S. Satish Kumar","doi":"10.4103/ijpn.ijpn_70_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_70_22","url":null,"abstract":"Neuropathic pain is associated with hyperalgesia, allodynia, and other paresthesia affecting the sleep, social, personal, and emotional life of a person. Numerous causes have been described for neuropathic pain. Nutritional deficiency is one uncommon cause. In this case report, we present a 27-year-old female patient who came to the pain clinic with severe burning pain, pricking sensation, and increased sensitivity to touch and pain for the past 2 months. The patient was diagnosed with thiamine deficiency and started on nutritional replacement therapy. A multidisciplinary approach involving drugs, physiotherapy along with replacement therapy was started, following which the patient started showing improvement in the symptoms.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"56 - 58"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46090464","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}
Mayank Gupta, Priyanka Gupta, Gegal Pruthi, H. Kumar
Airway and spine involvement in ankylosing spondylitis (AS) impose unique anesthetic challenges. Ankylosis and intervertebral space obliteration in AS make neuraxial anesthesia technically challenging and sometimes impossible. The anatomical variations of impalpable sacral cornu and complete or partially closed sacral hiatus in adults coupled with positioning difficulties, epidural space narrowing as well as an increased predilection for intraosseous or intravascular injection, and cauda equina syndrome complicate caudal anesthesia in AS. Combined ultrasound and fluoroscopic (ultrafluoro) guidance during caudal anesthesia improves accessibility and identifies and avoids any aberrant nonepidural injection. By providing a fluoroanatomical endpoint, i.e., local anesthetic (LA) contrast washout covering the concordant dermatomes, it reduces the amount of LA required and pressure build-up in already compromised epidural space. Ultrafluoro guidance improves accessibility, identifies, and avoids any nonepidural injection, and reduces the amount of LA required during caudal anesthesia in AS.
{"title":"UltraFluoro-guided low-dose caudal anesthesia in patients with ankylosing spondylitis: A case series delineating the technical, safety, and efficacy considerations","authors":"Mayank Gupta, Priyanka Gupta, Gegal Pruthi, H. Kumar","doi":"10.4103/ijpn.ijpn_63_22","DOIUrl":"https://doi.org/10.4103/ijpn.ijpn_63_22","url":null,"abstract":"Airway and spine involvement in ankylosing spondylitis (AS) impose unique anesthetic challenges. Ankylosis and intervertebral space obliteration in AS make neuraxial anesthesia technically challenging and sometimes impossible. The anatomical variations of impalpable sacral cornu and complete or partially closed sacral hiatus in adults coupled with positioning difficulties, epidural space narrowing as well as an increased predilection for intraosseous or intravascular injection, and cauda equina syndrome complicate caudal anesthesia in AS. Combined ultrasound and fluoroscopic (ultrafluoro) guidance during caudal anesthesia improves accessibility and identifies and avoids any aberrant nonepidural injection. By providing a fluoroanatomical endpoint, i.e., local anesthetic (LA) contrast washout covering the concordant dermatomes, it reduces the amount of LA required and pressure build-up in already compromised epidural space. Ultrafluoro guidance improves accessibility, identifies, and avoids any nonepidural injection, and reduces the amount of LA required during caudal anesthesia in AS.","PeriodicalId":32328,"journal":{"name":"Indian Journal of Pain","volume":"37 1","pages":"53 - 55"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46763628","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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