Nepalese version of Douleur Neuropathique 4 (DN4) questionnaire for detection of neuropathic pain signs and symptoms: Translation and psychometric properties.

OBJECTIVE: This study aimed to translate the DN4 questionnaire into Nepalese version and assess its psychometric properties: diagnostic accuracy, internal consistency, and test-retest reliability. METHODS: An observational study was conducted in a tertiary level teaching hospital of Kathmandu, Nepal. We included 166 patients with chronic pain visiting a pain clinic over a period of one year. The Nepalese version of the DN4 questionnaire was used for detecting signs and symptoms of neuropathic pain. The English version of the questionnaire was translated into Nepali in accordance with the standard guideline with the help of linguistic experts. The patients who met the inclusion criteria were examined and interviewed twice in an interval of two weeks. The association between the index test and the reference test was analyzed using Chi-square test. Diagnostic accuracy was assessed using sensitivity, specificity, Youden's index, and positive and negative predictive values. We calculated internal consistency using Cronbach's alpha (∝), and test-retest reliability using Cohen's kappa and Intra-class correlation coefficient (ICC). RESULTS: The study showed a significant association between the result of DN4 questionnaire and the gold standard (physician's diagnosis) (p<0.001). The sensitivity and specificity values for the DN4 questionnaire were 75% and 95.3% respectively. Similarly, positive and negative predictive values were 93.8% and 80.4% respectively. Our study showed adequate internal consistency (∝ = 0.710) and a good test-retest reliability (kappa = 0.872, ICC = 0.877). CONCLUSIONS: The Nepalese version of DN4 questionnaire is a valid and reliable tool for the identification of signs and symptoms of neuropathic pain. This can be used for screening neuropathic pain signs and symptoms in clinical as well as research settings.

Outcome of Pregnant Patients with Cardiac Diseases Delivered in Tribhuvan University Teaching Hospital.

BACKGROUND: Pregnant women with cardiac disease pose a unique challenge to both the anaesthesiologists and obstetrician because of high morbidity affecting the maternal and fetal outcomes. Our research aims to provide an overview of pregnant women with heart disease coming for delivery in Tribhuvan University Teaching Hospital over one year, the occurrence of adverse maternal and neonatal outcome (mortality and morbidity) and correlation of certain maternal factors associated with adverse outcome. METHODS: This is an observational cross-sectional study conducted in Tribhuvan University Teaching Hospital from 2075/11/01 to 2076/10/30 where data of pregnant women beyond 28 wks period of gestation with diagnosed cardiac disease was recorded from secondary sources. RESULTS: The prevalence of pregnant women with cardiac disease presenting for delivery over one-year period was found out to be 120 (2.49%). Among them, almost 85 cases (71%) had valvular heart disease and 27 had mitral stenosis. The mortality was 2.5%. The complication rate among such patients was 30%, the patients requiring ICU admission was 20.7% and requiring mechanical ventilation was 6.7%. The neonatal mortality in such patients was 3.2% and 20.5% were premature, 27% had weight <2.5 kgs at birth and 10.7% required NICU admission. There was statistically significant association between history of prior cardiac event and NYHA with adverse maternal event with p value of <0.001. CONCLUSIONS: History of prior cardiac event and higher NYHA grading in a pregnant patient with cardiac disease are major determinants for adverse maternal outcome.

Continuous Fascia Iliaca Compartment Block for Post Operative Analgesia in Fracture Femur.

The postoperative pain management in the elderly is challenging due to comorbidities and change in physiology due to age itself. This limit the use of medication which include pain medication also. The fascia iliaca compartment block has been described in the literature for fracture of femur. It has even been safely used by non anaesthesiologist also. To our knowledge, we did not find any case report of continuous fascia iliaca compartment block published in Nepal. This is our first experience of successful continous fasicia iliaca compartment block in case of 89 year old lady with multiple co morbidities in whom traditional pain medication might be difficult to use. We encourage to practice this block which is both safe and easy to perform with good results.