1.Interventional Pain Management in Rheumatological Diseases: A Three Years Physiatric Experience in a Tertiary Medical College Hospital in Bangladesh.
Md Abu Bakar SIDDIQ ; Suzon Al HASAN ; Gautam DAS ; Amin Uddin A KHAN
The Korean Journal of Pain 2011;24(4):205-215
BACKGROUND: Interventional pain management (IPM) is a branch of medical science that deals with management of painful medical conditions using specially equipped X-ray machines and anatomical landmarks. Interventional physiatry is a branch of physical medicine and rehabilitation that treats painful conditions through intervention in peripheral joints, the spine, and soft tissues. METHODS: A cross-sectional study was conducted using three years of hospital records (2006 to 2008) from the Physical Medicine and Rehabilitation Department at Chittagong Medical College Hospital in Bangladesh, with a view toward highlighting current interventional pain practice in a tertiary medical college hospital. RESULTS: The maximum amount of intervention was done in degenerative peripheral joint disorders (600, 46.0%), followed by inflammatory joint diseases (300, 23.0%), soft tissue rheumatism (300, 23.0%), and radicular or referred lower back conditions (100, 8.0%). Of the peripheral joints, the knee was the most common site of intervention. Motor stimulation-guided intralesional injection of methylprednisolone into the piriformis muscle was given in 10 cases of piriformis syndrome refractory to both oral medications and therapeutic exercises. Soft tissue rheumatism of unknown etiology was most common in the form of adhesive capsulitis (90, 64.3%), and is discussed separately. Epidural steroid injection was practiced for various causes of lumbar radiculopathy, with the exception of infective discitis. CONCLUSIONS: All procedures were performed using anatomical landmarks, as there were no facilities for the C-arm/diagnostic ultrasound required for accurate and safe intervention. A dedicated IPM setup should be a requirement in all PMR departments, to provide better pain management and to reduce the burden on other specialties.
Bangladesh
;
Bursitis
;
Cross-Sectional Studies
;
Exercise
;
Hospital Records
;
Injections, Intralesional
;
Joint Diseases
;
Joints
;
Knee
;
Methylprednisolone
;
Muscles
;
Pain Management
;
Physical and Rehabilitation Medicine
;
Piriformis Muscle Syndrome
;
Radiculopathy
;
Rheumatic Diseases
;
Spine
2.Reversible parkinsonism in central pontine and extrapontine myelinolysis: A report of five cases from India and review of the literature
Kamala Kant Bhoi ; Alak Pandit ; Gautam Guha ; Punnabrata Barma, Amar Kumar Misra ; Prabhat Kumar Garai ; Shyamal Kumar Das
Neurology Asia 2007;12(1):101-109
Parkinsonism with or without dystonia has been rarely described following central pontine myelinolysis
and extrapontine myelinolysis. We report 5 cases of reversible parkinsonism and dystonia with
imaging evidences of central pontine myelinolysis and extrapontine myelinolysis associated with
hyponatremia from a center in Eastern India. Their presentations varied from mild masked facies to
extra pyramidal syndromes characterized by progressive supranuclear palsy like feature and marked
dystonia. Two cases presented with flaccid quadriplegia later evolved into spasticity and dystonia.
The cause of hyponatremia was due to vomiting in two, diuretic-induced, nutritional and psychogenic
polydipsia one each. The onset was acute in 4, and gradual in one from psychogenic polydipsia. They
responded well to gradual correction of electrolyte imbalance, dopaminergic and antidystonic agents
including botulinum toxin. The movement disorders of central pontine myelinolysis with extrapontine
myelinolysis represent a treatable manifestationof the osmotic demyelination syndrome and rewarding
result can be achieved.
3.Evaluation of the Efficacy of Methylprednisolone, Etoricoxib and a Combination of the Two Substances to Attenuate Postoperative Pain and PONV in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Placebo-controlled Trial.
Sujeet GAUTAM ; Amita AGARWAL ; Pravin Kumar DAS ; Anil AGARWAL ; Sanjay KUMAR ; Sandeep KHUBA
The Korean Journal of Pain 2014;27(3):278-284
BACKGROUND: Establishment of laparoscopic cholecystectomy as an outpatient procedure has accentuated the clinical importance of reducing early postoperative pain, as well as postoperative nausea and vomiting (PONV). We therefore planned to evaluate the role of a multimodal approach in attenuating these problems. METHODS: One hundred and twenty adult patients of ASA physical status I and II and undergoing elective laparoscopic cholecystectomy were included in this prospective, randomized, placebo-controlled study. Patients were divided into four groups of 30 each to receive methylprednisolone 125 mg intravenously or etoricoxib 120 mg orally or a combination of methylprednisolone 125 mg intravenously and etoricoxib 120 mg orally or a placebo 1 hr prior to surgery. Patients were observed for postoperative pain, fentanyl consumption, PONV, fatigue and sedation, and respiratory depression. Results were analyzed by the ANOVA, a Chi square test, the Mann Whitney U test and by Fisher's exact test. P values of less than 0.05 were considered to be significant. RESULTS: Postoperative pain and fentanyl consumption were significantly reduced by methylprednisolone, etoricoxib and their combination when compared with placebo (P<0.05). The methylprednisolone + etoricoxib combination caused a significant reduction in postoperative pain and fentanyl consumption as compared to methylprednisolone or etoricoxib alone (P<0.05); however, there was no significant difference between the methylprednisolone and etoricoxib groups (P>0.05). The methylprednisolone and methylprednisolone + etoricoxib combination significantly reduced the incidence and severity of PONV and fatigue as well as the total number of patients requiring an antiemetic treatment compared to the placebo and etoricoxib (P<0.05). CONCLUSIONS: A preoperative single-dose administration of a combination of methylprednisolone and etoricoxib reduces postoperative pain along with fentanyl consumption, PONV, antiemetic requirements and fatigue more effectively than methylprednisolone or etoricoxib alone or a placebo.
Adult
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Cholecystectomy, Laparoscopic*
;
Fatigue
;
Fentanyl
;
Humans
;
Incidence
;
Methylprednisolone*
;
Outpatients
;
Pain, Postoperative*
;
Postoperative Nausea and Vomiting*
;
Prospective Studies*
;
Respiratory Insufficiency
4.Prevention of epidural catheter migration: a comparative evaluation of two tunneling techniques
Sujeet GAUTAM ; Anil AGARWAL ; Pravin Kumar DAS ; Sandeep KHUBA ; Sanjay KUMAR
Korean Journal of Anesthesiology 2021;74(1):59-64
Background:
Epidural analgesia failure episodes can be reduced by catheter fixation techniques with a lower incidence of catheter migration. In this clinical study, we compared the roles of two epidural catheter tunneling techniques for the prevention of epidural catheter migration.
Methods:
Patients undergoing major abdominal surgery were randomized into three groups of 50 patients each based on the method used to secure the epidural catheter. In the control group (CG), the epidural catheter was secured without tunneling. Tunneling groups 1 and 2 (TG1 and TG2) were defined as tunneling with and without a catheter loop, respectively. The primary outcome measure was the migration of the epidural catheter, while the secondary outcome measures were the adequacy of analgesia and signs of inflammation. All patients were followed up by the acute pain service team twice daily in the postoperative period until the epidural catheter was removed. The results were analyzed by the one-way analysis of variance (ANOVA), chi-square test, and Fisher’s exact test. P values <0.050 were considered significant.
Results:
The three groups were similar with respect to patient characteristics. Catheter migration was significantly reduced in TG2 (two patients) compared to those in the other two groups, i.e., TG1 (eight patients) (P = 0.045) and CG (17 patients) (P = 0.001). No differences were found amongst the three groups in analgesia adequacy and catheter site inflammation (P > 0.050).
Conclusions
Catheter migration was significantly reduced by tunneling without a catheter loop in TG2 as compared to the other two groups. Therefore, we suggest routine use of tunneling without a catheter loop technique in anesthesia practice and look forward to future studies with larger sample sizes.