Background: Endoscopic surgeries are minimally invasive surgeries to treat sinus pathologies. The challenges faced by the anesthesiologist are to provide bloodless field of surgery, to maintain hemodynamic stability, and to reduce anesthetic supplementation to facilitate early recovery of the patient. The preferred anesthesia is general with controlled ventilation, stable surgical field, and airway protection with adequate anesthesia. Problems faced during the procedure are to keep the minimum the bleeding during surgery so that a better visibility of the endoscopic magnified surgical field, faster awakening after reversal of general anesthesia, faster return of protective airway reflexes, and optimal postoperative analgesia. Sphenopalatine ganglion block (SPGB) has proven an effective adjuvant to general anesthesia during sinonasal surgery. Reduced bleeding increases visibility and reduces operative time with reduced complications and better results. In our study, SPGB was supplemented with the general anesthesia to evaluate the comfort of operability, opioid supplementation, inhalation anesthetic requirement, and intraoperative and postoperative complications. Materials and methods: Our study is a randomized controlled triple-blind study with 30 patients in each group. In both the groups, general anesthesia was given. In group I, SPGB was given with a 10 mL of 1% xylocaine local anesthetic, and in group II, SPGB was given with placebo. Results: We have observed that there is a reduced intraoperative and postoperative bleeding in group I, the field of vision is better in group I, and fentanyl supplementation and isoflurane consumption was less in group I. The intraoperative and postoperative complications were less in group I. Conclusion: Sphenopalatine ganglion block regional anesthesia is reliable supplementation to general anesthesia in endonasal endoscopic procedures to provide stable surgical field with reduced anesthetic requirement and minimal intraoperative and postoperative complications.

Aim: Providing labor analgesia has always been a challenge, more so because of controversies and myths associated with labor. This study was done to observe the effect of patient-controlled epidural labor analgesia on incidence of conversion to cesarean section, maternal satisfaction, maternal complication and neonatal outcomes. Materials and methods: A total of 25 consenting ASA grade I–II parturients in active labor with a cervical dilatation of 3–5 cm were randomly selected for the study. The labor analgesia was given after putting epidural catheter in L2/L3 intervertebral space and then parturient were put on continuous infusion of ropivacaine 0.1% with PCA pump after bolus dose of ropivacaine 0.2% with 25 μg fentanyl. The parturients were observed for the incidence of instrumental delivery and incidence of conversion to cesarean section along with duration of labor, maternal satisfaction score and fetal outcome. Results: The rate of cesarean sections was 8.3% in labor analgesia parturients. Only one forceps delivery was done in labor analgesia parturients. No neonatal deaths were noted in labor analgesia parturients. No major maternal complications like hypotension or bradycardia were encountered. The mean satisfaction score was 3.88/5 in study group. Conclusion: Patient-controlled labor analgesia with low dose ropivacaine infusion with PCA pump provides excellent maternal satisfaction for patients undergoing normal vaginal delivery along with decrease in cesarean section rate and good fetal outcome. Clinical significance: Patient-controlled labor analgesia using PCA pump is a novel technique and it provides nearly painless vaginal delivery to the parturient along with excellent fetal outcome and with minimal maternal side-effects.

Introduction: The primary objective is to investigate the feasibility of proposed percutaneous ultrasound long axis (LA; in-plane) guided approach for celiac plexus neurolysis (CPN) in patients with advanced pancreatic cancer. The present study also aimed to assess the outcome as well as to document complications specific to the proposed technique if any. Materials and methods: Celiac plexus neurolysis under LA ultrasound (USG) guidance was performed in thirty one patients (mean age of 58.2 ± 4.7 years) of either-sex (24 men and 7 women) suffering from chronic pain due to pancreatic cancer [visual analog scale (VAS) score > 4] not responding to any pharmacological treatment or in those where opioids-related adverse effects are poorly tolerated. Follow-up was done immediately after injection, first day, 1 week, 4 weeks and 12 weeks following intervention and on an as needed basis thereafter. Post-neurolysis and at each subsequent follow-up visit, pain scores, satisfaction rate and other complications were studied. Level of statistical significance was set at a p < 0.05. Results: At 12 weeks CPN under LA ultrasound guidance was associated with significant pain relief, reduced NSAIDS/opioids consumption and improved patient satisfaction (p < 0.05). There were no major peri- and/or postoperative complications. Conclusion: Celiac plexus neurolysis under LA USG guidance enhances effectiveness and was associated with better pain relief, reduced NSAIDS/opioids consumption and improved patient satisfaction. Clinical significance: Celiac plexus neurolysis under LA USG guidance enhances effectiveness of pain relief and level of safety in patients with abdominal malignancies.

Lumbar disk herniation with radiculitis is commonly presented as low back pain radiating down the lower extremity unilaterally along the affected dermatome. There can be various presentations of lumbar radiculopathy such as nondermatomal distribution of pain, patchy distribution of pain, and mismatch between clinical presentation and image findings. Symptoms of lumbar radiculopathy or radiculitis typically aggravate on walking and have partial relief on rest and forward bending. We got an atypical case of herniated lumbar disk where the patient presented with absence of low back pain, absence of pain along the thigh, older age, and pain aggravating on sitting. It emphasizes that one should not exclude any clinical diagnoses unless proved.

High number of patients coming to pain clinic complain of low back pain (LBP) and this puts the pain physician in lot of diagnostic predicament. Consideration of common reasons from myofascial pain generator to rarer like cluneal nerve entrapment requires updating of knowledge regarding various rare pain generators in the back region. The cutaneous branches of cluneal nerve, namely, superior and middle are purely sensory. They provide sensation in the lumbar region and the buttocks, and their impingement around the iliac crest can cause LBP radiating to lower limb. Diagnosing uncommon cause for LBP owing to superior cluneal nerve impingement becomes a challenging task due to the absence of any diagnostic criteria apart from the high-index suspicion based on clinical findings and ruling out other common causes of LBP. It is usually misdiagnosed as a lumbar spine disorder. Here we present a case of chronic low backache with vague symptoms, which was successfully treated with the cluneal nerve block and the diagnosis of cluneal nerve entrapment was confirmed.

Background: Deafferentation pain is a subdivision of neuropathic pain that may complicate virtually any type of injury to the somatosensory system at any point along its course.¹ Anesthesia dolorosa or deafferentation pain is felt in an area (usually in the face) which completely becomes numb to touch. The pain is described as constant, burning, aching, or severe.² Case description: A 24-year-old male came with a complaint of severe pain in the left outer aspect of thigh and leg, which did not reduce with any medication. Ten years ago, he had undergone wound exploration for cut injury over the outer aspect of upper part of lower leg. Since then he had been having mild to moderate pain which increased in the past 1 year. His evaluation demonstrated neurofibroma of common peroneal nerve at the lacerated end. Excision of this was done to relieve the patient from pain but instead the pain increased. Examination of leg showed sensory and motor loss over the distribution of common peroneal nerve. Provisional diagnoses of, deafferentation pain of common peroneal nerve, with the differential diagnosis of complex regional pain syndrome (CRPS) type II,³ nerve entrapment, laceration of common peroneal nerve, stump neuroma were kept in mind. Conclusion: Deafferentation pain is difficult to treat. One has to be careful while dissecting the nerve during surgery, which may lead to deafferentation pain.

We report a case of 28-year-old female who presented with progressively worsening low back pain since 1 year and anterolateral thigh pain since one and half months. Anterolateral thigh pain is not an uncommon condition in pain management practice and it is usually due to entrapment of lateral femoral cutaneous nerve. It can be associated with low back pain which can commonly be of diskogenic origin especially in patients of younger age group. On clinical evaluation, prima facie this patient's symptoms appeared to be due to meralgia paresthetica with lumbar diskogenic pain. However, on investigation it has been found that a nerve sheath tumor was responsible for the patient's symptoms. This case underlines the need of an open approach during the evaluation of the patient even if the case appears to have spot diagnosis.

Introduction: Cervical disk herniation causes neck pain and arm pain due to direct impingement of nerve roots along with the associated inflammation. Clinical features generally correspond to the side of herniation. Case description: Our case report is about a 38-year-old female, schoolteacher by occupation presenting to hospital with neck pain radiating to right upper limb with tingling sensation along the C5 and C6 nerve root distribution. Magnetic resonance imaging of cervical spine showed posterolateral protrusion in C3–C4, C4–C5, C5–C6, disk compressing exiting nerve roots left more than right along with osteophytes causing canal stenosis.

Fibromyalgia is a common chronic syndrome defined by core symptoms of widespread musculoskeletal pain and stiffness throughout the connective tissues that support and move the bones and joints. Other common symptoms include cognitive difficulty, headache, paresthesia, morning stiffness, fatigue, and sleep disturbance. Fibromyalgia is increasingly understood as one of the several disorders that are referred to as central sensitivity syndromes. Tender points are often detected in patients with fibromyalgia. We report a case of 43-year-old female who presented with painful nodule over the palm and later developed generalized pain. Combination therapies with pregabalin, nortriptyline, and ketamine infusion relieved her symptoms over time. The management of fibromyalgia requires a multidimensional approach including patient education, cognitive behavioral therapy, exercise, and pharmacologic therapy. We present a case of fibromyalgia, which was initially treated with a combination of above modalities with partial benefit but actually benefited via ketamine infusion.