Phonophoresis Plus Topical Nitroglycerin or Hydrocortisone for the Management of Plantar Fasciitis, Which Topical Agent is Superior?

Background: Plantar fasciitis (PF) is the most common reason for inferior heel pain. Various approaches have been raised for the treatment of PF; however, none had substantial outcomes. The current study aims to assess and compare phonophoresis outcomes plus topical nitroglycerin versus phonophoresis plus topical hydrocortisone for PF management. Materials and Methods: The current study has been conducted on 65 patients with PF diagnosis, among whom underwent ten every-other-day sessions of treatment with phonophoresis plus 20 mg nitroglycerin (n=33) or 20mg hydrocortisone (n=32), respectively. The Modified Roles and Maudsley (RM) score and the visual analog scale (VAS) were compared between the two groups at baseline, three weeks, and two months after the interventions. Besides, the plantar fascia thickness was measured at baseline and two months after the intervention. Results: The baseline RM (P-value=0.067) and pain severity (P-value=0.057) was similar between the two groups, but other assessments revealed the superiority of phonophoresis plus topical nitroglycerin over topical hydrocortisone (P-value<0.05). The reduction in plantar fascia thickness was more in phonophoresis plus nitroglycerin-treated patients as compared to the latter group (P-value<0.001), but the requirement of additional doses of analgesia was remarkably more in hydrocortisone-treated patients (P-value<0.001). Conclusion: Based on the current study, phonophoresis plus topical nitroglycerin was superior to phonophoresis plus topical hydrocortisone in pain relief, improved quality of life, and decreased fascia thickness. However, further investigations are required to achieve the ultimate outcomes for a more extended period.[GMJ.2021;10:e2072] DOI:10.31661/gmj.v10i0.2072

Topical nitroglycerin for management of peripheral extravasation of vasopressors: a case report

ABSTRACT Peripheral route for administration of vasopressors is often opted due to resource limitations or as a rescue until central venous access is established. This, however, is not devoid of complications, the most common being extravasation and tissue injury. Phentolamine is the only drug approved for management of vasopressor extravasation; however, successful use of other agents has been reported. Here we report a case of peripheral extravasation of vasopressors, successfully managed with topical nitroglycerin in intensive care unit in Kathmandu. To our knowledge, this is the first report of such kind from Nepal.