1.Less explored off-label indications of dexmedetomidine.
Korean Journal of Anesthesiology 2017;70(3):361-362
No abstract available.
Dexmedetomidine*
2.Does subepineural injection damage the nerve integrity?A technical report from four amputated limbs
Sandeep DIWAN ; Abhijit NAIR ; Parag SANCHETI ; André Van ZUNDERT
The Korean Journal of Pain 2021;34(1):132-136
Local anesthetic (LA) injection outside the sheath in epineural or paraneural connective tissue is considered safe practice among regional anesthesiologists. There is limited evidence as to whether neurological complications occur if LA is injected inside the sheath (subepineural - intraneural). We performed ultrasound guided injections at the level of undivided sciatic nerve in four amputated lower limbs. In two specimens, LA was injected in epineural connective tissue (paraneural tissue) and in another two specimens by penetrating the outer nerve sheath (hyperechoic epineurium). Ultrasonography demonstrated an increase in the size of nerve and macroscopic findings revealed fascicular tracings with sub-epineural injections. Limbs were sent for histological analysis in formalin containers. Pathologist performed the analysis which demonstrated an intact perineurium and a breach in the epineurium. We conclude that sub-epineural injections are unsafe and injection should be done in paraneural tissue to ensure safety and avoid unwanted neurological sequelae after the block.
3.Does subepineural injection damage the nerve integrity?A technical report from four amputated limbs
Sandeep DIWAN ; Abhijit NAIR ; Parag SANCHETI ; André Van ZUNDERT
The Korean Journal of Pain 2021;34(1):132-136
Local anesthetic (LA) injection outside the sheath in epineural or paraneural connective tissue is considered safe practice among regional anesthesiologists. There is limited evidence as to whether neurological complications occur if LA is injected inside the sheath (subepineural - intraneural). We performed ultrasound guided injections at the level of undivided sciatic nerve in four amputated lower limbs. In two specimens, LA was injected in epineural connective tissue (paraneural tissue) and in another two specimens by penetrating the outer nerve sheath (hyperechoic epineurium). Ultrasonography demonstrated an increase in the size of nerve and macroscopic findings revealed fascicular tracings with sub-epineural injections. Limbs were sent for histological analysis in formalin containers. Pathologist performed the analysis which demonstrated an intact perineurium and a breach in the epineurium. We conclude that sub-epineural injections are unsafe and injection should be done in paraneural tissue to ensure safety and avoid unwanted neurological sequelae after the block.
4.Ultrasound Guided Transversus Abdominis Plane Block for Anterior Cutaneous Nerve Entrapment Syndrome.
Rajendra Kumar SAHOO ; Abhijit S NAIR
The Korean Journal of Pain 2015;28(4):284-286
Anterior cutaneous nerve entrapment syndrome (ACNES) is one the most common cause of chronic abdominal wall pain. The syndrome is mostly misdiagnosed, treated wrongly and inadequately. If diagnosed correctly by history, examination and a positive carnett test, the suffering of the patient can be relieved by addressing the cause i.e. local anaesthetic with steroid injection at the entrapment site. Conventionally, the injection is done by landmark technique. In this report, we have described 2 patients who were diagnosed with ACNES who were offered ultrasound guided transverses abdominis plane (TAP) injection who got significant pain relief for a long duration of time.
Abdominal Muscles
;
Abdominal Pain
;
Abdominal Wall
;
Anatomic Landmarks
;
Chronic Pain
;
Diagnosis
;
Humans
;
Nerve Block
;
Nerve Compression Syndromes*
;
Ultrasonography*
5.Bilateral transnasal sphenopalatine block for treating postdural puncture headache
Korean Journal of Anesthesiology 2018;71(1):73-74
No abstract available.
Post-Dural Puncture Headache
6.The risks associated with erector spinae plane block in patients with abnormalities of coagulation
Abhijit S NAIR ; Suresh SEELAM
Korean Journal of Anesthesiology 2019;72(3):275-276
No abstract available.
Humans
7.Subcoracoid tunnel block as an alternative infraclavicular brachial plexus approach -a case series-
Sandeep DIWAN ; Divya SETHI ; Avinash GAIKWAD ; Parag SANCHETI ; Abhijit NAIR
Korean Journal of Anesthesiology 2020;73(5):450-454
Background:
Magnetic resonance neurography shows the brachial plexus cords in the subcoracoid tunnel beneath the pectoralis minor. With an ultrasound scan along the brachial line, the brachial plexus cords in the subcoracoid tunnel can be targeted using an in-plane needle approach. We describe this new approach to the infraclavicular block called the “subcoracoid tunnel block.”Case: Twenty patients were administered with the ultrasound-guided subcoracoid tunnel block for the below-elbow surgery. The contact of the needle tip with cords was visible in all 20 patients. With neurostimulation, the posterior cord was identified in 11 (55%) and medial cord in 9 (45%) patients on the first needle pass. The subcoracoid tunnel block was successful in 16 patients (80%).
Conclusions
Our case series shows that the subcoracoid tunnel block is an excellent alternative technique for the infraclavicular block. Its advantages include better needle-cord visibility and easy identification of the brachial plexus cords.
10.Sphenopalatine ganglion block for relieving postdural puncture headache: technique and mechanism of action of block with a narrative review of efficacy.
Abhijit S NAIR ; Basanth Kumar RAYANI
The Korean Journal of Pain 2017;30(2):93-97
The sphenopalatine ganglion (SPG) is a parasympathetic ganglion, located in the pterygopalatine fossa. The SPG block has been used for a long time for treating headaches of varying etiologies. For anesthesiologists, treating postdural puncture headaches (PDPH) has always been challenging. The epidural block patch (EBP) was the only option until researchers explored the role of the SPG block as a relatively simple and effective way to treat PDPH. Also, since the existing evidence proving the efficacy of the SPG block in PDPH is scarce, the block cannot be offered to all patients. EBP can be still considered if an SPG block is not able to alleviate pain due to PDPH.
Blood Patch, Epidural
;
Ganglia, Parasympathetic
;
Ganglion Cysts
;
Headache
;
Humans
;
Pain Management
;
Post-Dural Puncture Headache*
;
Pterygopalatine Fossa
;
Sphenopalatine Ganglion Block*