Anudeep Saxena

Myofascial pain syndrome: an overview.

ABSTRACT Over the last few decades, advances have been made in the understanding of myofascial pain syndromes (MPSs). In spite of its high prevalence in the society, it is not a commonly established diagnosis. MPS is said to be the great imitator. This article puts some light on the various clinical presentations of the syndrome, on the various tools to reach to a diagnosis for commencing the treatment and on the treatment modalities that have been used so far.

Effect of pregabalin premedication on the requirement of anesthetic and analgesic drugs in laparoscopic cholecystectomy: Randomized comparison of two doses

Background: Preoperative medication has a vital role in anesthesia. Pregabalin (PG) is a newer drug of gabapentinoid class and is six times more potent than gabapentin. Our study was designed to evaluate the effect of PG as premedication on the perioperative anesthetic requirement and analgesia. Materials and Methods: The study was conducted on ninety patients of American Society of Anesthesiologists Grade I and II of age group 20–60 years, allocated to one of the three groups of thirty patients each. Group I received tablet diazepam 10 mg HS and 5 mg 1 h before surgery, Group II received capsule PG 75 mg HS and 150 mg 1 h before surgery, and Group III received capsule PG 75 mg HS and 300 mg 1 h before surgery. Patients were induced with injection fentanyl citrate, thiopentone sodium, and rocuronium bromide and maintained by 66% N2O + 33% O2gas mixture with sevoflurane and intermittent boluses of fentanyl. Results: Perioperative consumption of thiopentone sodium was 5.59 ± 0.49 mg/kg in Group I, 4.29 ± 0.53 mg/kg in Group II, and 4.06 ± 0.59 mg/kg in Group III; fentanyl was 1.55 ± 0.42 μg/kg in Group I, 1.00 ± 0.00 μg/kg in Group II, and 1.05 ± 0.20 μg/kg in Group III; sevoflurane (%) was 1.20 ± 0.31 in Group I, 0.933 ± 0.25 in Group II, and 1.00 ± 0.00 in Group III. Perioperative requirement of thiopentone sodium, opioid, and inhalational agent was significantly less in Group II and III when compared with Group I. Maximum number of patients required postoperative rescue analgesia within 0–2 h of surgery in Group I, 2–4 h of surgery in Group II, and 6–8 h after surgery in Group III. Patients were more comfortable and asleep with a longer pain-free postoperative period in PG groups. Conclusion: PG premedication effectively reduced the consumption of all anesthetic agents during induction and maintenance of anesthesia as compared to diazepam. Patients postoperative comfort and pain-free duration were also greater with PG premedication; more so with PG 300 mg as compared to PG 150 mg.

Single dose intravenous dexmedetomidine prolongs spinal anesthesia with hyperbaric bupivacaine

Background and Introduction: Spinal block, a known technique to obtain anaesthesia for infraumblical surgeries. Now physician have advantage of using adjuvant to prolong the effect of intrathecal block, which can be given either intravenously or intrathecally, dexmedetomidine is one of them. We studied effect of intravenous dexmedetomidine for prolongation of duration of intrathecal block of 0.5% bupivacaine block. Objective: To evaluate the effect of intravenous dexmedetomidine on sensory regression, hemodynamic profile, level of sedation and postoperative analgesia. Methodology: 60 patients of ASA grade I and II posted for elective infraumblical surgeries were included in the study and randomly allocated into two groups. Group D recieved intrathecal 0.5% bupivacaine heavy, followed by infusion of intravenous dexmedetomidine 0.5mic/kg over 10 min, patients in group C received intrathecal 0.5% bupivacaine heavy 3ml followed by infusion of same volume of normal saline as placebo. Results: Two segment regression of sensory block was achieved at 139.0 ± 13.797 in group D whereas in group C it was only 96.67 ± 7.649min, the total duration of analgesia achieved in both study groups was 234.67 ± 7.649min and 164.17 ± 6.170min respectively in group D and group C. The time at which first analgesic was given to the patients when VAS >3 achieved that is in group D at 234.67 ± 7.649min and in group C at 164.17 ± 6.170min. Inj diclofenac sodium 75mg intramuscular was used as rescue analgesic.

Unusual presentation of rate-dependent intermittent transient bundle branch block in a patient with head injury

A 41-year-old male patient without co-morbidities, suffering with right fronto-temporo-parietal subdural haematoma (SDH) of 90cc approximately following head injury presented with Glasgow coma score (GCS) of 4/15 (motor response 2) in the emergency department. He was operated on the same day. In the NSICU, on day 2, it was noticed that the patient’s electrocardiogram showed changes of LBBB or tachy-brady syndrome intermittently. This coincided with increase in patient’s heart rate, as evident on the 12-lead ECG [Figure 1]. An acute myocardial event was suspected. This patient was evaluated by cardiologist and intensivist. Serial Troponin-T/I and bedside 2D-echocardiography was performed, which was within normal limits. Intravenous metoprolol dose 50 mg was administered for the high blood pressure and heart rate but had to be discontinued soon after the LBBB pattern reverted to normal and the patient suffered sinus bradycardia. Undesirable sympathetic stimulation leading to LBBB may occur at the time of tracheal or oropharyngeal suctioning and during periodic change in position of patient in ICU. This was managed by deepening the plane of sedation and using sympatholytic drugs such as esmolol and lignocaine.

A well known and important adverse effect of phenytoin in a neurosurgical patient

Gum hypertrophy is a well-known and important adverse effect of phenytoin therapy in a neurosurgical patient. We present an interesting case of a 21-year-old man who, following head injury after a road traffic accident, developed status epilepticus diagnosed with gum hypertrophy in the jaws, with ongoing antiepileptics. He was managed conservatively as per hospital protocol.

A novel use of nasopharyngeal airway in managing airway leak

We report a case of severe maxillofacial injury, who while undergoing later stages of reconstruction surgeries, presented with an inimitable kind of air leak during mask ventilation and its interesting management using a nasopharyngeal airway. The case also enlightens the importance of evaluating the available computed tomography images as a part of preanesthetic check-up.