Chansoria M. Scope of Pain Clinics in India. J Recent Adv Pain 2017;3(2):59-60.

To investigate the prevalence of pain in medical representatives exposed to two-wheeler riding compared with medical representatives using other modes of commuting.

A total of 105 medical representatives participated in the study with history of exposure to traveling of at least 300 minutes per week with at least 60 minutes per day for 5 days a week for more than 1 year. Fifty-two of them traveled by two-wheelers and were grouped under “two-wheeler group” and 53 were grouped under “control group” as they used bus, train, or car (not self-driven) as a mode of commute. The prevalence and intensity of pain was assessed by Numeric Rating Scale (NRS) for baseline pain and worst pain, Pain Disability Index (PDI), and the Pain diagram for the pain observed during last 2 weeks.

Statistically significant difference was observed in pain levels between the two groups (two-wheeler group vs control group): Numeric Rating Scale baseline pain (p = 0.0315), NRS worst pain (p = 0.0388), and PDI (p = 0.010). The pain scores of the two-wheeler group showed positive dose–response relation with time of exposure to riding. The pain distribution pattern between two-wheeler group vs control group was quiet different with lower back pain 36 vs 23% and ankle foot pain 2 vs 12%.

The study concludes that medical representatives traveling using two-wheelers as compared with bus, train, or car suffer from more cumulative trauma.

Two-wheeler users have significantly higher prevalence of pain and pain-associated disability due to cumulative trauma disorder, which warrants further studies to improve the depth of our understanding about cumulative traumas.

Chawathe VS, Mhambre AS, Gaur AK, Pusnake VJ, Sharma R, Wangdi NI. Prevalence of Pain in Medical Representatives using Two-wheeler for Daily Commute. J Recent Adv Pain 2017;3(2):61-65.

To evaluate the adequacy of combined psoas and sacral plexus block (SPB) as a sole anesthetic agent, patients'/surgeons' satisfaction, perioperative urinary retention, and duration of postoperative analgesia for unilateral lower limb surgeries.

A single-center prospective study was conducted between March and August 2016 on 101 patients undergoing elective unilateral lower limb surgeries under combined psoas and SPB belonging to American Society of Anesthesiologists physical status 1 and 2, aged between 18 and 60 years. Adequacy of block, patients'/surgeons' satisfaction, perioperative urinary retention, and duration of postoperative analgesia were noted.

Among the 101 patients, 1 patient was excluded from the study. In 93 patients (93%), the block was adequate. Among the patients with adequate block, the surgeons' and patients' satisfaction was 95.7 and 96.8% respectively. Eight patients were catheterized preoperatively and rest of the 92 patients (100%) voided spontaneously without any intervention. The average time of first analgesic dose was 347.7 ± 103.7 min.

Combined psoas and SPB is a good and a safe alternative to neuraxial block in patients undergoing unilateral lower limb surgeries with good surgeon and patient satisfaction, lesser incidence of urinary retention, and prolonged postoperative pain relief.

Vinod K, Kuhrekar P, Sharanya K, Raghuraman MS. Study on evaluating the Adequacy of Psoas Compartment Block and Sacral Plexus Block for Lower Limb Surgeries. J Recent Adv Pain 2017;3(2):66-70.

To assess the postoperative analgesic effect of intra-articular dexmedetomidine, when administered as an adjuvant with bupivacaine in arthroscopic knee surgeries.

A total of 60 patients undergoing elective unilateral knee arthroscopy under general anesthesia were randomly assigned to two groups (n = 30). Group Bupivacaine and Saline (BS) received intra-articularly 19 mL of 0.5% bupivacaine and 1 mL of isotonic saline (total volume 20 mL). Group Bupivacaine and Dexmedetomidine (BD) received intra-articular 100 µg dexmedetomidine (1 mL) added to 19 mL of 0.5% bupivacaine. Pain assessment using visual analog scale (VAS) was done at regular intervals for 24 hours and rescue analgesia given accordingly.

Increased VAS scores (p-value 0.005, <0.001, 0.002) and increased use of supplementary analgesic (p-value 0.042, 0.026, 0.024) were seen in group BS (control group) compared with group BD (study group), at intervals of 30 minutes, 1 hour, and 2 hours. Mean duration of analgesia (time for first analgesic requirement) was longer in group BD (median 4 hours) compared with BS (median 1 hour) (p-value 0.012).

Intra-articular dexmedetomidine administered as an adjuvant to bupivacaine improves the quality and duration of postoperative analgesia after knee arthroscopy.

A myriad of agents have been studied for their potential use in attenuating postoperative pain following knee arthroscopy, but despite multiple studies with various agents, no single agent has been found to be clearly superior to the rest. In such a scenario, dexmedetomidine provides an interesting option.

Pal A, Chatterji C, Muralidhar V, Mehra C, Madhok H. Comparative Evaluation of Intra-articular Bupivacaine vs Intra-articular Bupivacaine and Dexmedetomidine for Postoperative Analgesia in Arthroscopic Knee Surgery. J Recent Adv Pain 2017;3(2):71-76.

Postoperative pain influences the long-term outcome of the patient in a big way. We performed a randomized prospective double-blind study to evaluate the effects of intravenous (IV) nalbuphine and compared it with IV pentazocine. The primary objective was to compare the duration of analgesia of IV nalbuphine and IV pentazocine and the secondary objective was to study the side-effect profile.

Sixty American Society of Anesthe­siologists (ASA) physical status I and II patients undergoing short-duration surgery under general anesthesia were randomly allocated in two groups of 30 each to receive either nalbuphine (group I) or pentazocine (group II) IV. The duration of postoperative analgesia, need for rescue analgesia, and side effects if any were monitored. Two-sample t-tests were used to investigate and model the impact of various parameters like duration of analgesia and side-effect profile.

Duration of analgesia in group I (7.43 ± 1.63 hours) was significantly prolonged as compared with group II (4.73 ± 1.62 hours). Statistical significance (p < 0.05) was noted. Significance was not noted between the two groups when sedation score was compared.

Intravenous nalbuphine is superior to IV pentazocine in providing analgesia and causes less sedation.

Apte VY, Bhalerao PM, Lokapur MA, Sancheiti RP, Kelkar KV. Comparison of Analgesic Effects of Intravenous Nalbuphine and Pentazocine in Patients posted for Short-duration Surgeries: A Prospective Randomized Double-blinded Study. J Recent Adv Pain 2017;3(2):77-80.

Khandaker N, Ahmed SM, Hasan I, Banik A. Neck Pain in a Young Girl: A Pott's Disease Case Study. J Recent Adv Pain 2017;3(2):81-84.

To prolong the duration of brachial plexus block, different adjuvants have been used. We evaluated the effect of adding magnesium sulfate to local anesthetic ropivacaine 0.4% for institution of supraclavicular brachia plexus block. Onset of sensory and motor block, duration of motor block, and rescue analgesia were observed.

Total 120 patients (20–50 years) scheduled for elective surgeries of upper limb under supraclavicular brachial plexus block were randomized into two groups. Group I received 24 mL 0.5% ropivacaine (120 mg) + 6.0 mL normal saline (NS) to make total volume of 30 mL. Group II received 24 mL 0.5% ropivacaine (120 mg) + 150 mg magnesium sulfate + 5.5 mL NS to make total volume of 30 mL.

Onset of sensory block in group I was 16.63 ± 2.79 min and in group II was 17.33 ± 2.25 min (statistically not significant, p > 0.05). Onset of motor block in group I was 18.63 ± 2.79 min and in group II was 19.76 ± 2.18 min (statistically significant, p < 0.05). The duration of motor block was significantly longer in group II; 322.00 ± 81.35 min than group I; 260.25 ± 66.79 min (p < 0.05). Similarly, time of rescue analgesia was significantly prolonged in group II; 491 ± 100.22 min than group I; 377.67 ± 73.31 min (p < 0.05).

From our study, we concluded that the addition of 150 mg magnesium sulfate as adjuvant to 30 mL of 0.4% ropivacaine in comparison to 30 mL of 0.4% ropivacaine provides longer duration of analgesia. Although the onset of sensory block is not affected, onset of motor block is delayed. Motor block lasts for longer duration.

Gupta D, Mangal V, Sharma G, Kulshestha A, Kalra P. Efficacy of Magnesium Sulfate as Adjuvant to Ropivacaine 0.4% for Supraclavicular Brachial Plexus Block in Patients undergoing Upper Limb Surgery: A Randomized Controlled Trial. J Recent Adv Pain 2017;3(2):85-89.

The ability to isolate and visualize the “pain” generators in the foramen and treat persistent pain by visualizing inflammation and compression of nerves serves as the basis for transforaminal endoscopic (TFE) surgery.It provides a least invasive basic access to the disc. One of the important steps is the insertion of dilator and working sleeve followed by introduction of endoscope. Often this step is carried out with the help of a hammer, which is agonizing for the patients undergoing surgery. This study aims at analyzing the efficacy of the rami communicans nerve block in reducing the intraoperative pain in patients undergoing TFE discectomy.

A total of 48 patients undergoing TFE discectomy were assigned into two groups. Group I (case, n = 27) received rami communicans block prior to endoscopic discectomy and for group II (control, n = 21), no rami communicans block was given. Under all aseptic precautions, the rami communicans block was given to group I patients after identification of corresponding level. After proper placement of block, lumbar TFE discectomy was performed using the “inside-out” approach. Pain was assessed using numerical rating scale (NRS) at different time intervals. Statistical analysis was carried out using independent Student's t-test, chi-squared test, and Mann–Whitney U test.

While comparing NRS, group I showed significantly lower NRS when compared with group II and it was highly significant (p-value < 0.0001). The need for rescue analgesia was also compared and this difference was also found to be highly significant (p-value < 0.0001).

The rami communicans block is highly effective in reducing the intraoperative pain in patients undergoing TFE discectomy and thus, reduces the total dose of anesthetics and analgesics intraoperatively.

Das G, Dey S, Sharma RS, Sharma K, Dutta D, Roy C. Rami Communicans Block Prior to Transforaminal Endoscopic Discectomy relieves Procedure Pain Significantly and adds Safety: A Case–control Study. J Recent Adv Pain 2017;3(2):90-95.

Das G, Nagaraj PB, Chavda P. Caudal Epidural Steroid Injection in Pain Management. J Recent Adv Pain 2017;3(2):96-98.

Headache is a symptom which may be asso­ciated with a variety of clinical conditions whether the underlying disorder be organic, psychologic or psychophysiologic. Headache disorders can be classified as primary, secondary and specific types of headache.

Patients usually present with primary headache in primary health care settings. More than one type of primary headache may be present in one patient and each headache has to be treated separately. Migraine is the most common severe primary headache disorder.

Every presentation of headache requires care to exclude organic disease, and every presentation provides the opportunity to relieve suffering.

Upadhyay R, Chansoria M, Mahobia M, Vyas N. Headache, Primary Headaches and Their Treatment. J Recent Adv Pain 2017;3(2):99-104.

Sharma RS, Das G, Hamdi T. Case of Difficult Identification of Foramen Ovale: Radiofrequency Ablation of Gasserian Ganglion for Trigeminal Neuralgia Secondary to Squamous Cell Carcinoma in a Posthemimandibulectomy, Hemimaxillectomy Patient. J Recent Adv Pain 2017;3(2):105-107.

Hamdi T, Sharma RS, Das G, Barik P. Management of an Atypical Case of Recurrent Trigeminal Neuralgia, switching from V2 to V3 Division: A Case of Resistant Trigeminal Neuralgia. J Recent Adv Pain 2017;3(2):108-110.