1.Ultrasound-guided pulsed radiofrequency ablation of stellate ganglion in upper-extremity phantom limb pain: a case series
Ajit KUMAR ; Manasa KANTHA ; Sonal GOYAL ; Pradeep ATTER
Anesthesia and Pain Medicine 2024;19(4):349-352
Background:
Phantom limb pain (PLP) is the most common type of pain experienced by amputees and is chronic and complex, with manifestations including pain in a limb that no longer exists. To date, treatments that are pharmaceutical or surgical in nature are relatively ineffective at bringing much relief as the pathophysiology of PLP is somewhat obscure. Chronic pain syndromes such as PLP may benefit from sympathetic nervous system modulation through the stellate ganglion.Case Ten refractory PLP patients treated with ultrasound-guided stellate ganglion pulsed radiofrequency ablation (SG PRF) after a diagnostic stellate ganglion block took effect: A case series Patients were assessed before and after the treatment at 1 week, 1 month, and 3 months. Significant reductions in pain as measured using a numerical rating scale; Pain Disability Indexwas improved, and Medication Quantification Scale also was improved. Minimal side effects.
Conclusions
Ultrasound-guided SG PRF has provided promising results for PLP by giving the patient with sustained pain relief and functional improvement without much side effects. Further studies need to be done to validate this finding.
2.Ultrasound-guided pulsed radiofrequency ablation of stellate ganglion in upper-extremity phantom limb pain: a case series
Ajit KUMAR ; Manasa KANTHA ; Sonal GOYAL ; Pradeep ATTER
Anesthesia and Pain Medicine 2024;19(4):349-352
Background:
Phantom limb pain (PLP) is the most common type of pain experienced by amputees and is chronic and complex, with manifestations including pain in a limb that no longer exists. To date, treatments that are pharmaceutical or surgical in nature are relatively ineffective at bringing much relief as the pathophysiology of PLP is somewhat obscure. Chronic pain syndromes such as PLP may benefit from sympathetic nervous system modulation through the stellate ganglion.Case Ten refractory PLP patients treated with ultrasound-guided stellate ganglion pulsed radiofrequency ablation (SG PRF) after a diagnostic stellate ganglion block took effect: A case series Patients were assessed before and after the treatment at 1 week, 1 month, and 3 months. Significant reductions in pain as measured using a numerical rating scale; Pain Disability Indexwas improved, and Medication Quantification Scale also was improved. Minimal side effects.
Conclusions
Ultrasound-guided SG PRF has provided promising results for PLP by giving the patient with sustained pain relief and functional improvement without much side effects. Further studies need to be done to validate this finding.
5.Ultrasound-guided pulsed radiofrequency ablation of stellate ganglion in upper-extremity phantom limb pain: a case series
Ajit KUMAR ; Manasa KANTHA ; Sonal GOYAL ; Pradeep ATTER
Anesthesia and Pain Medicine 2024;19(4):349-352
Background:
Phantom limb pain (PLP) is the most common type of pain experienced by amputees and is chronic and complex, with manifestations including pain in a limb that no longer exists. To date, treatments that are pharmaceutical or surgical in nature are relatively ineffective at bringing much relief as the pathophysiology of PLP is somewhat obscure. Chronic pain syndromes such as PLP may benefit from sympathetic nervous system modulation through the stellate ganglion.Case Ten refractory PLP patients treated with ultrasound-guided stellate ganglion pulsed radiofrequency ablation (SG PRF) after a diagnostic stellate ganglion block took effect: A case series Patients were assessed before and after the treatment at 1 week, 1 month, and 3 months. Significant reductions in pain as measured using a numerical rating scale; Pain Disability Indexwas improved, and Medication Quantification Scale also was improved. Minimal side effects.
Conclusions
Ultrasound-guided SG PRF has provided promising results for PLP by giving the patient with sustained pain relief and functional improvement without much side effects. Further studies need to be done to validate this finding.
6.Ultrasound-guided pulsed radiofrequency ablation of stellate ganglion in upper-extremity phantom limb pain: a case series
Ajit KUMAR ; Manasa KANTHA ; Sonal GOYAL ; Pradeep ATTER
Anesthesia and Pain Medicine 2024;19(4):349-352
Background:
Phantom limb pain (PLP) is the most common type of pain experienced by amputees and is chronic and complex, with manifestations including pain in a limb that no longer exists. To date, treatments that are pharmaceutical or surgical in nature are relatively ineffective at bringing much relief as the pathophysiology of PLP is somewhat obscure. Chronic pain syndromes such as PLP may benefit from sympathetic nervous system modulation through the stellate ganglion.Case Ten refractory PLP patients treated with ultrasound-guided stellate ganglion pulsed radiofrequency ablation (SG PRF) after a diagnostic stellate ganglion block took effect: A case series Patients were assessed before and after the treatment at 1 week, 1 month, and 3 months. Significant reductions in pain as measured using a numerical rating scale; Pain Disability Indexwas improved, and Medication Quantification Scale also was improved. Minimal side effects.
Conclusions
Ultrasound-guided SG PRF has provided promising results for PLP by giving the patient with sustained pain relief and functional improvement without much side effects. Further studies need to be done to validate this finding.
7.Ultrasound-guided pulsed radiofrequency ablation of stellate ganglion in upper-extremity phantom limb pain: a case series
Ajit KUMAR ; Manasa KANTHA ; Sonal GOYAL ; Pradeep ATTER
Anesthesia and Pain Medicine 2024;19(4):349-352
Background:
Phantom limb pain (PLP) is the most common type of pain experienced by amputees and is chronic and complex, with manifestations including pain in a limb that no longer exists. To date, treatments that are pharmaceutical or surgical in nature are relatively ineffective at bringing much relief as the pathophysiology of PLP is somewhat obscure. Chronic pain syndromes such as PLP may benefit from sympathetic nervous system modulation through the stellate ganglion.Case Ten refractory PLP patients treated with ultrasound-guided stellate ganglion pulsed radiofrequency ablation (SG PRF) after a diagnostic stellate ganglion block took effect: A case series Patients were assessed before and after the treatment at 1 week, 1 month, and 3 months. Significant reductions in pain as measured using a numerical rating scale; Pain Disability Indexwas improved, and Medication Quantification Scale also was improved. Minimal side effects.
Conclusions
Ultrasound-guided SG PRF has provided promising results for PLP by giving the patient with sustained pain relief and functional improvement without much side effects. Further studies need to be done to validate this finding.
8.Epidemiology of Traumatic Spinal Cord Injury in the Himalayan Range and Sub-Himalayan region: A Retrospective Hospital Data-Based Study
Osama NEYAZ ; Vinay KANAUJIA ; Raj Kumar YADAV ; Bhaskar SARKAR ; Md. Quamar AZAM ; Pankaj KANDWAL
Annals of Rehabilitation Medicine 2024;48(1):86-93
Objective:
To compile epidemiological characteristics of traumatic spinal cord injury (TSCI) in the Northern Indian Himalayan regions and Sub-Himalayan planes.
Methods:
The present study is a retrospective, cross-sectional descriptive analysis based on hospital data conducted at the Department of Physical Medicine and Rehabilitation and Spine Unit of Trauma Centre in a tertiary care hospital in Uttarakhand, India. People hospitalized at the tertiary care center between August 2018 and November 2021 are included in the study sample. A prestructured proforma was employed for the evaluation, including demographic and epidemiological characteristics.
Results:
TSCI was found in 167 out of 3,120 trauma patients. The mean age of people with TSCI was 33.5±13.3, with a male-to-female ratio of 2.4:1. Eighty-three participants (49.7%) were from the plains, while the hilly region accounts for 50.3%. People from the plains had a 2.9:1 rural-to-urban ratio, whereas the hilly region had a 6:1 ratio. The overall most prevalent cause was Falls (59.3%), followed by road traffic accidents (RTAs) (35.9%). RTAs (57.2%) were the most common cause of TSCI in the plains’ urban regions, while Falls (58.1%) were more common in rural plains. In both urban (66.6%) and rural (65.3%) parts of the hilly region, falls were the most common cause.
Conclusion
TSCI is more common in young males, especially in rural hilly areas. Falls rather than RTAs are the major cause.
9.Efficacy of interventional treatment strategies for managing patients with cervicogenic headache: a systematic review
Sonal GOYAL ; Ajit KUMAR ; Priyanka MISHRA ; Divakar GOYAL
Korean Journal of Anesthesiology 2022;75(1):12-24
Cervicogenic headache (CeH) is caused by the disorder of the cervical spine and its anatomical structures. Patients who fail to respond to conservative therapies can undergo interventional treatment. The purpose of this review is to describe the various interventions and compare their relative efficacies. Although a few reviews have been published focusing on individual interventions, reviewing studies on other available treatments and establishing the most efficacious approach is still necessary. We performed a systematic review of studies available on the various interventions for CeH. The PubMed, Embase, and Cochrane databases were searched for literature published between January 2001 and March 2021. Based on the inclusion criteria, 23 articles were included. Two reviewers independently extracted the data from the studies and summarized them in a table. Eleven of twenty-three studies evaluated the effect of radiofrequency ablation (RFA), 5 evaluated occipital nerve blocks, 2 each for facet joint injections and deep cervical plexus blocks, and 1 study each evaluated atlantoaxial (AA) joint injections, cervical epidural injection, and cryoneurolysis. Most of the studies reported pain reduction except 2 studies on RFA. In conclusion, based on the available literature, occipital nerve blocks, cervical facet joint injection, AA joint injection, deep cervical plexus block, cervical epidural injection may be reasonable options in refractory cases of CeH. RFA was found to have favorable long-term outcomes, while better safety has been reported with pulsed therapy. However, our review revealed only limited evidence, and more randomized controlled trials are needed to provide more conclusive evidence.
10.Use of a human patient simulator for apnea studies: a preliminary in vitro trial
Debendra Kumar TRIPATHY ; Mridul DHAR ; Bharat Bhushan BHARDWAJ ; K HEMANTHKUMAR ; Praveen TALAWAR ; Shalinee RAO
Korean Journal of Anesthesiology 2022;75(5):437-444
Background:
Modern human patient simulators (HPSs) could be used for researching critical scenarios such as apnea oxygenation. We aimed to study the use of a high-fidelity HPS to assess prolonged apnea using various oxygenation strategies with a simple high-flow nasal cannula (15 L/min).
Methods:
An experimental simulation study using an HPS (CAE Healthcare™) was conducted after obtaining approval from the Institutional Review Board. The HPS responded according to real-time physiologically modeled responses to external gases, such as oxygen (O2). Apnea experiments were performed with different physiological settings, such as shunt fraction (5%) and O2 consumption (250, 500, and 750 ml/min). The following four apnea experiments were conducted: no oxygenation (NO), apnea oxygenation alone (AO), preoxygenation alone (PO), and para-oxygenation (PAO). The time to 92%, 75%, and 50% saturation was recorded. Alveolar and arterial gas levels were recorded till 50% saturation.
Results:
At 250 ml/min, PO (1121 s) and PAO (1274.5 s) had a significantly longer time to 50% saturation (400% increase) compared to NO (222.5 s) and AO (239 s). A similar trend was observed for the time to 92% and 75% saturation. At higher O2 consumption rates, a shorter time to desaturation was observed.
Conclusions
Apnea trends in the HPS correlated with similar prior human experiments. AO without preoxygenation was found to provide no additional benefit. Preoxygenation with high-flow O2 via nasal cannula prolonged the time to desaturation in the PAO more than PO scenario. Therefore, HPSs can be used in future studies where patient safety is a concern.

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