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Background and Aims: In India, the awareness about the psycho-social dimension of chronic pain is minimal among physicians and patients. The research with community-based group therapies (like mindfulness) to address the psycho-social aspects in chronic pain patients remains limited. The aim of this randomized controlled trial was to see the effects of mindfulness on pain intensity, pain catastrophizing, chronic pain acceptance, perceived stress, well-being, and mindfulness characteristics. Materials and Methods: In this two-site, parallel group, clinical trial, 170 patients attending pain outdoors of two government hospitals in West Bengal, India, were randomized to attend five weekly in-person mindfulness sessions (cases) or usual care sessions (controls) within the hospital premises. Pre-program and post-program data were collected and analyzed using statistical methods like repeated measures analysis of variance. Results: In participants of the mindfulness group, significant changes post session were noted in pain intensity [F(1,326) = 15.0122; P = 0.0001291], pain acceptance [F(1,326) = 4.5311; P = 0.03403], and perceived stress score [F(1,326) = 13.2788; P = 0.0003122] compared to pre-session. The changes in pain catastrophizing, World Health Organization well-being and Freiburg mindfulness inventory scores were non-specific. Conclusion: Mindfulness had a positive influence on pain intensity, pain acceptance, and perceived stress of Indian chronic pain patients. The effects on pain catastrophizing, mindfulness characteristics, and well-being (non-specific) were also encouraging. Further studies will be required to substantiate these results.
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BACKGROUND AND AIMS: Various opioid additives have been trialed to prolong brachial plexus block. We evaluated the effect of adding nalbuphine hydrochloride to levobupivacaine for supraclavicular brachial plexus blockade. The primary end-points were the onset and duration of sensory and motor blocks and duration of analgesia. MATERIALS AND METHODS: Seventy-eight patients (aged 25-45 years) posted for ambulatory forearm and hand surgery under supraclavicular brachial plexus block were divided into two equal groups (Groups LN and LC) in a randomized, double-blind fashion. In Group LN (n = 39), 30 ml 0.5% levobupivacaine + 10 mg (diluted in 2 ml 0.9% saline) nalbuphine hydrochloride, and in Group LC (n = 39), 30 ml 0.5% levobupivacaine + 2 ml normal saline (0.9%) were administered in supraclavicular block. Sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, postoperative visual analog scale (VAS), hemodynamics, and side effects were recorded for each patient. RESULTS: Although with similar demographic profile and block (sensory and motor) onset time, sensory and motor block duration and time to first analgesic use were significantly longer and the total need for rescue analgesics was lower in Group LN (P < 0.05) than Group LC. Postoperative VAS value at 24 h was significantly lower in Group LN (P < 0.05). Intraoperative hemodynamics was comparable between two groups, and no any appreciable side effect was noted throughout the study period. CONCLUSION: It can be concluded that adding nalbuphine hydrochloride to supraclavicular brachial plexus block increases the sensory and motor block duration and time to first analgesic use, and decreases total analgesic use with no side effects.
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Dexmedetomidine has predictable, complex, and negative cardiovascular effects that lead to additional adverse effects such as bradycardia and hypotension in up to 42% of patients and might cause profound left ventricular dysfunction and refractory shock. Usually, these temporary effects can be successfully counteracted with atropine, ephedrine, and volume supplementation. Clinicians need to be well informed about the potential of dexmedetomidine to cause bradycardia, which may progress to pulseless electrical activity, particularly in patients older than 50 years and patients with cardiac abnormalities. Here, we report the clinical characteristics of six patients who were scheduled for various neurosurgical procedures within a period of three months and suffered from cardiac arrest following dexmedetomidine administration. We urge clinicians to take caution against the negative effects of dexmedetomidine, especially when it is used in patients older than 50 years with underlying cardiac disease and in combination with cardiodepressant drugs.