Unilateral spinal anesthesia is more favorable than bilateral spinal anesthesia. This study was done to compare hemodynamic changes and time to first postoperative analgesic requirement in patients undergoing unilateral and bilateral spinal anesthesia for lower limb surgeries.

A prospective, randomized study was done in 60 patients of American Society of Anesthesiologists grade 1 undergoing lower limb surgery. Patients were randomized into two groups. Group A (n = 30) received bilateral spinal anesthesia, and group B (n = 30) received unilateral spinal anesthesia. Onset, duration, and time to reach maximum height of sensory block; duration of analgesia; and hemodynamic variables were studied in the two groups.

Duration, time to reach maximum height of sensory block, and duration of analgesia were longer in group B. There were less hemodynamic changes in group B.

Unilateral spinal anesthesia offers more favorable hemodynamic and postoperative analgesic outcome when compared with bilateral spinal anesthesia.

Dongre D, Mahobia M, Narang N. Comparison between Hemodynamic Changes and Time to First Postoperative Analgesic Requirement in Patients undergoing Unilateral and Bilateral Spinal Anesthesia for Lower Limb Surgeries. J Recent Adv Pain 2016;2(2):39-43.

Spinal anesthesia is the most common approach used for lower abdominal surgeries. Levobupivacaine 0.5% and racemic bupivacaine 0.5% are equally effective in spinal anesthesia. Dexmedetomidine (a highly selective alpha-2 adrenergic agonist) and fentanyl (short-acting synthetic opioid) are effective intrathecal adjuvants. The aim of our study was to evaluate onset and duration of sensory and motor block, duration of postoperative analgesia, and side effects on addition of dexmedetomidine and fentanyl as adjuvants to hyperbaric 0.5% levobupivacaine along with the control group.

Ninety patients of American Society of Anesthesiologists (ASA) grade I/II undergoing infraumbilical surgery were studied in a prospective, double blind, controlled study. Levobupivacaine was made hyperbaric by adding 1 mL of 25% dextrose to 12.5 mg levobupivacaine. Patients were randomly allocated to receive either 12.5 mg hyperbaric levobupivacaine + normal saline (group A, n = 30) or 12.5 mg hyperbaric levobupivacaine + 25 μg fentanyl (group B, n = 30) or 12.5 mg hyperbaric levobupivacaine + 5 μg dexmedetomidine (group C, n = 30) intrathecally.

Patients in the dexmedetomidine group had significantly longer sensory and motor block time than patients in the fentanyl and control groups. Mean time of sensory regression to S1 was 161.2 ± 14.6, 180.3 ± 6.2, and 472.5 ± 8.7 minutes in groups A to C respectively (p < 0.0001). Duration of analgesia was prolonged to 259.4 ± 12.8 minutes in group C as compared with 114.0 ± 14.3 and 161.8 ± 8.5 minutes in the control and fentanyl group respectively (p < 0.0001).

Intrathecal 5 μg dexmedetomidine seems to be an attractive alternative to 25 μg fentanyl as adjuvant to 0.5% hyperbaric levobupivacaine in spinal anesthesia. It is associated with prolonged motor and sensory block and provides good quality of intraoperative analgesia and extended duration of postoperative analgesia as compared with fentanyl.

Jain S, Sharma G, Bafna U, Jain D, Meena S, Jetley P. A Comparative Study of Intrathecal Fentanyl and Dexmedetomidine as Adjuvants to Hyperbaric Levobupivacaine 0.5% and Hyperbaric Levobupivacaine 0.5% Alone in Infraumbilical Surgeries. J Recent Adv Pain 2016;2(2):44-48.

Magnesium sulfate has recently gained popularity as an adjuvant to general anesthesia. It acts as a blocker of N-methyl D-aspartate (NMDA) antagonist and hence may have a potential role in the prevention of postoperative pain. The aim of the present prospective, randomized, double-blind, and placebocontrolled study was to evaluate the efficacy of injection magnesium sulfate 50 mg/kg as premedication upon postoperative pain and analgesic requirement in patients undergoing elective laparoscopic cholecystectomy under general anesthesia.

After obtaining institutional ethical committee approval, 100 patients of American Society of Anesthesiologists (ASA) grade 1 and 2 undergoing laparoscopic cholecystectomy under general anesthesia were randomly allocated into two groups to receive either 50 mg/kg magnesium sulfate in normal saline to a total volume of 5 mL (group M, n = 50) or 5 mL of normal saline (group S, n = 50) as premedication prior to general anesthesia. The patients were continuously monitored for postoperative pain using visual analog scale (VAS) in the immediate postoperative period and subsequently at 2-hour intervals for the next 24 hours. Injection tramadol 1 mg/kg was given as the rescue analgesic (VAS ≥ 4).

Both the groups were comparable with respect to demographic variables. There was no statistically significant difference in the postoperative VAS scores (p = 0.489) and tramadol requirement among the groups (p = 0.38).

Magnesium sulfate 50 mg/kg premedication is ineffective in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy under general anesthesia.

Singh A, Khandelwal H, Negi A, Dutta B, Rani P. A Prospective Randomized and Double-blind Study to evaluate the Efficacy of Magnesium Sulfate on Postoperative Analgesic Requirement in Patients undergoing Laparoscopic Cholecystectomy. J Recent Adv Pain 2016;2(2):49-53.

Interspinous ligament is an uncommon but potential pain generator in the spinal column that can give rise to chronic low backache. Interspinous ligament sprain is difficult to diagnose with radiologic imaging, such as X-ray, and magnetic resonance imaging. Only meticulous history and diagnostic block help in making a proper diagnosis. This case report describes a case of interspinous ligament sprain in a young male patient who presented with a history of chronic low back pain. His imaging studies revealed no abnormalities and the diagnostic local anesthetic infiltration confirmed the diagnosis.

Kulkarni R, Ramyashree RM. Interspinous Ligament as a Pain Generator. J Recent Adv Pain 2016;2(2):54-55.

Injury to the dural membrane during spinal surgery may result in persistent cerebrospinal fluid (CSF) leak. Prompt management to stop this CSF leak is warranted to avoid serious neurological consequences. Many surgical and nonsurgical interventional techniques including epidural blood patch have been advocated. We present a case report where transforaminal epidural blood patch was used successfully to manage persistent CSF leak after laminectomy.

Jadon A, Jain P. Postoperative Cerebrospinal Fluid Leak managed with Transforaminal Epidural Blood Patch. J Recent Adv Pain 2016;2(2):56-58.

Meralgia paresthetica is common but often remains unrecognized. The condition is managed with conservative therapy in most cases. Rarely, surgery is required. If it remains unresolved, it can lead to chronic pain. Research on rehabilitation therapy of meralgia paresthetica is sparse. Mirror therapy is a simple, noninvasive neurorehabilitation technique without side effects. We investigated the role of mirror therapy with brushing of thigh in our patient who has already been treated with various conservative therapies without any improvement. Our patient showed effective pain relief after mirror therapy.

Dabgotra M, Das G, Malik S, Bhattarai R. Mirror Visual Feedback Treatment for Meralgia Paresthetica. J Recent Adv Pain 2016;2(2):59-61.

Reported is a case of “idiopathic coccydynia” with chronic pain which was refractory to conservative, medical, and interventional treatment. A diagnosis of central sensitization with coccydynia was made, and the patient responded very well to desensitization program with lignocaine and clonidine mixture. Central sensitization has proven its identity in fibromyalgia, chronic low back pain, and arthritis. But reports in coccydynia are lacking. This case report highlights the role and successful treatment of central sensitization in chronic “idiopathic coccydynia.”

Malik S, Das G, Dabgotra M, Datta M. Coccydynia with Central Sensitization plays an Important Role as Pain Generator. J Recent Adv Pain 2016;2(2):62-64.

Dexmedetomidine, an a 2 agonist used as infusion with scalp block, is a good adjuvant with analgesic, anxiolytic, and sedative effect with minimal effects on hemodynamic changes and respiration depression. In this study, we report the efficacy of dexmeditomidine for awake craniotomy.

Three American Society of Anesthesiologists grade 2 patients were posted for tumor resection under awake craniotomy. Scalp block was given with local anesthetic and dexmedetomidine bolus dose of 1 μg/kg/hr followed by 0.2 to 0.4 μg/kg/hr. The patient's speech was monitored by oral questionnaire, motor strength by hand squeezing, and sedation by modified Ramsay Hunt Score.

Bolus dose of 1 μg/kg over 20 minutes infusion of 0.2 to 0.4 μg/kg/hr is a good adjuvant with scalp block with minimal hemodynamic changes.

Dexmedetomidine is a useful adjuvant during awake craniotomy for tumor resection. It has minimal effect on hemodynamics and respiratory system. It can be used in procedures where cooperation of the patient is required intraoperatively.

Naik SS, Kumar L, Mohanty SK, Banakal S, Channakeshava L. Anesthesia in Awake Craniotomy: Advantages of Dexmedetomidine Infusion over Conventional Methods. J Recent Adv Pain 2016;2(2):65-68.