Efficacy of Ultrasonography Guided Erector Spinae Plane Block for Perioperative Analgesia in Percutaneous Nephrolithotomy

BACKGROUND Erector spinae block is a paraspinal, fascial block that targets the ventral, dorsal rami and rami communications of spinal nerves. The present study was conducted to know the efficacy of ultrasound guided erector spinae block (ESP) block in preoperative analgesia among patients with percutaneous nephrolithotomy (PCNL) attending a tertiary care hospital. METHODS The study was carried out on 596 patients from Jan 2015 to Jan 2020 who were indicated for PCNL. They were divided into two groups, group A (ESP = 373) and group B (intravenous-IV analgesia = 273). In the group A (N = 373), after induction of general anaesthesia, ESP block with 0.5 % bupivacaine and 1 / 200,000 epinephrine (single shot) was given at lower thoracic level (T10 - 12) and IV analgesia was given in group B. All patients were monitored for supplemental opioid requirement intraoperatively as assessed by their haemodynamic status (baseline change in heart rate-HR & mean arterial blood pressure-MAP). The primary outcome of the study was consumption of tramadol in 24 hrs. Pain assessment every 2-hour pre- and post-operatively using numerical rating (NR) scale was considered as the secondary outcome. Categorical outcomes were compared between study groups using chi-square test / Fisher's exact test; Pvalue of < 0.05 was considered statistically significant using IBM SPSS. RESULTS Most of them in group A were free of pain for 24 hours postoperatively with numerical rating scale score of < 3 and did not require any postop rescue analgesics. Only 1 patient showed numerical rating scale score of 4 around 16 hrs. after the surgery and was given tramadol. Supplemental opioid analgesic was not required by any of the patients during the entire intraoperative period. CONCLUSIONS ESP block is a favourable technique that results in very good analgesic effect preoperatively and also lessens the use of intravenous opioids and other analgesics. KEYWORDS ESP Block, PCNL Surgery, Tramadol, Kidney Stones

Effect of Complex Korean Medicine Treatment on Sacral Insufficiency Fracture: A Case Report

Sacral insufficiency fractures (SIF) are a common, but often underdiagnosed source of lower back pain without apparent trauma. This report presents the clinical outcome of a 75-year-old female with SIF, and an underlying medical history of osteoporosis and rheumatoid arthritis. She was treated non-operatively, in-hospital, with Korean medicine. Patient progress was assessed using the numerical rating scale and selfreported symptoms. Post-treatment, the numerical rating scale score for pain in her hip decreased from 7 to 2. At admission, the patient was unable to sit, and could only walk 3 m with assistance. At discharge, she could sit for longer than 1 hour and walk further than 200 m unassisted. On the follow-up visit, the patient was asymptomatic, and x-ray scans showed ossification of the sacral and pubic fractures. These results suggest that, Korean medicine can effectively reduce pain and aid rehabilitation in patients with SIF, without the need for surgery.

A PROSPECTIVE SURVEY OF APPROPRIATENESS OF PAIN PHARMACOTHERAPY MANAGEMENT IN POST-CESAREAN SECTION PATIENTS IN CIPTO MANGUNKUSUMO HOSPITAL

Objective: In this study, we sought to assess the pattern of analgesic usage, adequacy of pain management, side effects, and analgesic drug interactionsin the post-emergency cesarean surgery setting.Methods: This was a prospective observational study of 80 patients who underwent emergency cesarean surgery at the Obstetrics and GynecologyDepartment of the Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPN-CM) between July 2015 and January 2016. Adequacy of painmanagement during the first 3 post-operative days was assessed using Pain Management Index. Relation between pain intensity during activities andrest with patient characteristic was assessed using Chi-squared test and Fischer’s exact test.Results: Nineteen patients (8.7%) were prescribed two types of nonsteroid anti-inflammatory drugs concomitantly, and 41.8% received inappropriateanalgesics at a lower frequency. Most patients experienced pain with numerical rating scale score >3 in the first 24 h post-surgery: 59 patients(73.75%) experienced pain during activities and 7 patients (8.75%) during rest.Conclusion: Post-emergency cesarean surgery pain management at RSUPN-CM was not optimal. Most patients did not receive adequate painmanagement in the first 24 h post-surgery.

Treatment of Neuropathic Pain with 5% Lidocaine-Medicated Plaster: Five Years of Clinical Experience

BACKGROUND: Neuropathic pain is often severe and adversely affects patients’ quality of life.OBJECTIVE: To perform a retrospective, observational study investigating the efficacy and safety of treating refractory chronic neuropathic pain with 5% lidocaine-medicated plaster, in patients attending pain centres.METHODS: Medical records from 467 patients treated with 5% lidocaine-medicated plaster were evaluated for efficacy (maximum and minimum pain intensities and coanalgesic consumption) and adverse events. Data from an initial assessment and at least one follow-up visit had to be available, and separate analyses were conducted for the general population and the subpopulation older than 70 years of age.RESULTS: Of the patients enrolled, 25.0% were older than 70 years of age. While 20.6% had postherpetic neuralgia, 76.3% had other types of peripheral pain. Approximately 78.1% of cases of peripheral neuropathic pain followed surgery, and 23% were post-traumatic pain. The time from onset to referral was more than one year in two-thirds of cases. All patients experienced pain of at least moderate severity (mean [± SD] 11-point numerical rating scale score 5.2±2.4 to 8.2±1.6). Treatment with 5% lidocaine-medicated plaster reduced pain intensity by more than 50% in 45.5% of patients, and by at least 30% in 82.2%. Of note, the consumption of analgesics and coanalgesics was significantly reduced. Results were similar in both the general population and the subpopulation older than 70 years of age, at high risk and often receiving multiple medications.CONCLUSIONS: Treatment of refractory neuropathic pain with 5% lidocaine-medicated plaster clearly demonstrated efficacy and an excellent safety profile in patients with refractory neuropathic pain.

Analgesic and Antihyperalgesic Properties of Propofol in a Human Pain Model

Background Propofol (Disoprivan, AstraZeneca AG, Zug, Switzerland) has long been considered to be nonanalgesic. However, accumulating evidence shows that propofol possesses modulatory action on pain processing and perception. In this study, the authors investigated the modulatory effects of propofol and a formulation similar to the solvent of propofol (10% Intralipid; Fresenius Kabi, Stans, Switzerland) on pain perception and central sensitization in healthy volunteers. Methods Fourteen healthy volunteers were included in this randomized, double-blind, placebo-controlled, crossover study. Intracutaneous electrical stimulation (48.8 +/- 25.8 mA) induced spontaneous acute pain (Numeric Rating Scale, 6 of 10) and stable areas of hyperalgesia and allodynia. Pain intensities and areas of hyperalgesia were assessed regularly before, during, and after a 45-min target-controlled infusion (2 microg/ml) of propofol, the solvent 10% Intralipid, and saline. Results During administration, propofol significantly decreased pain scores and areas of hyperalgesia and allodynia compared with both 10% Intralipid and saline (placebo-corrected mean Numerical Rating Scale score reduction by propofol: 38 +/- 28%). This difference disappeared shortly after cessation of the infusion. Thereafter, no significant group differences were observed in the Numerical Rating Scale score and the areas of hyperalgesia or allodynia. However, there was a trend to reduced hyperalgesia and allodynia after propofol treatment. Pharmacodynamic modeling regarding the analgesic effect of propofol showed an EC50 (half-maximum effect site concentration) of 3.19 +/- 0.37 microg/ml. Ten percent Intralipid was free of pain-modulatory effects in the authors' experiments. Conclusions Propofol showed short-lasting analgesic properties during its administration, whereas the solvent-like formulation 10% Intralipid had no effect on pain perception.