Effectiveness of integrated approach of yoga therapy versus usual care in management on chronic low back pain patients: A randomized controlled pilot study.

BACKGROUND: Chronic low back pain is associated with both psychological and functional limitation. Yoga therapy has been shown to improve both the aspects. The present study was planned to evaluate integrated approach of yoga therapy with usaul care. AIMS: This controlled randomized trial was done to evaluate the clinical and molecular changes resulting from integrated approach of yoga therapy (IAYT) as an adjunct regimen and compared it with usual care for the management of chronic low back pain patients. MATERIAL AND METHODS: We enrolled 29 adult patients with non-specific chronic low back pain (CLBP). Patients were randomly divided into two groups. The control group received the usual care of treatment as per institutional protocol. The yoga group received IAYT as an adjunct to usual care. Primary outcomes were pain intensity assessed by verbal numerical rating scale (VNRS) and functional ability assessed by Modified Oswestry Disability Index (MODI). Secondary outcomes were pain catastrophizing, quality of life, fear of movement related to CLBP, type of pain, levels of ß-endorphin and TNF-α, and salivary CGRP. All parameters were measured at baseline, 1 and 3 months. RESULTS: A Significant decrease in VNRS score at 1 and 3 months was observed in both the groups with the yoga group showing a more significant reduction in pain over time than the control group (p = 0.036). MODI improved significantly only in the yoga group at 1 and 3 months. Intergroup comparison revealed significantly better MODI over time in the yoga group (p < 0.001). DN4, PDQ, PCS, HADS (anxiety), and Euro QOL had a statistically significant improvement at 1 and 3 months in the yoga group compared with the control group. The HADS (depression) had a statistically significant reduction scores in the yoga group at 3 months compared with the control group (p = 0.012). There was a significant reduction in TNF-α values in the yoga group compared with baseline (p = 0.004). CONCLUSION: IAYT therapy helped in addressing the psychological components of pain and improved quality of life patients with chronic low back pain compared with usual care.

A Preliminary Feasibility Study on Hemodynamic Changes Following Feyh-Kastenbauer Retractor Insertion During Transoral Robotic Surgeries.

 Introduction Transoral robotic surgery (TORS) has become increasingly popular for the removal of pharyngeal and laryngeal cancers with the objective to improve functional and aesthetic outcomes. Feyh-Kastenbauer (FK) retractor is one such routinely used retractor during TORS. The setting up of this retractor has been seen to be accompanied by hemodynamic fluctuations. Methodology This prospective observational study was carried out on 30 patients undergoing TORS. All patients were administered general anesthesia using a pre-defined anesthesia protocol. The primary outcome was to compare hemodynamic fluctuations following endotracheal intubation with that after FK retractor insertion. Any requirement of a bolus dose of sevoflurane and fentanyl was recorded in response to hemodynamic fluctuations recorded in secondary outcomes. Results There was no statistically significant increase in mean heart rate, systolic, diastolic, and mean arterial blood pressure from baseline to endotracheal intubation and following retractor insertion (p=0.810, p=0.2, p=0.6, p=0.3 respectively). On subgroup analysis, hypertensive patients reported a greater rise in blood pressure following two minutes post FK retractor insertion compared to non-hypertensive patients (p=0.03). Out of 30 patients, five patients required a bolus dose of sevoflurane. Conclusion FK retractor insertion had a comparable hemodynamic response as endotracheal intubation during TORS. Hypertensive patients showed a rise in blood pressure at both endotracheal intubations and at FK retractor insertion.

Management of a Multiple Endocrine Neoplasia 1 Patient in Pregnancy.

Multiple endocrine neoplasia (MEN) syndrome has rarely been reported during pregnancy. The multiple manifestations of the syndrome along with the normal body changes associated with pregnancy can prove to be difficult to manage. We describe our experience of the diagnosis and management of MEN1 syndrome in a pregnant female.

Utility of Point-of-Care Ultrasonography in Diagnosing Submassive Pulmonary Thromboembolism in a Trauma Patient and Subsequent Anesthetic Management: Case Report and Literature Review.

Point-of-care ultrasonography is defined as ultrasonography brought to the patient's bedside and performed by the provider in real time. The clinician can use these real-time dynamic images immediately (rather than images recorded by a sonographer and interpreted later), allowing findings to be directly correlated with the patient's presenting signs and symptoms. Point-of-care ultrasonography is easily repeatable if the patient's condition changes. Over the past decade, the use of point-of-care ultrasonography has extended to emergency settings and intensive care units. The role of ultrasound in triage patients is not only limited to the Focused Assessment with Sonography for Trauma which includes assessment for hemoperitoneum and hemopericardium, it has also been used to detect the presence of hemothorax, pneumothorax, and intravascular filling status in a trauma patient. However, the use of ultrasonography in detecting pulmonary thromboembolism in trauma has not been commonly reported. We report a patient in whom submassive pulmonary embolism was detected by lung ultrasound and thereafter operated for bilateral open Grade III lower-limb fractures. The surgery was proceeded under bilateral ultrasound-guided femoral sciatic nerve block.

Extended duration pulsed radiofrequency for the management of refractory meralgia paresthetica: a series of five cases.

Meralgia paresthetica (MP) is a sensory mononeuropathy, caused by compression of the lateral femoral cutaneous nerve (LFCN) of thigh. Patients refractory to conservative management are treated with various interventional procedures. We report the first use of extended duration (8 minutes) pulsed radiofrequency of the LFCN in a case series of five patients with refractory MP. Four patients had follow up for 1-2 years, and one had 6 months follow up. All patients reported remarkable and long lasting symptom relief and an increase in daily life activities. Three patients came off medications and two patients required minimal doses of neuropathic medications. No complications were observed.

Tramadol sparing effect of dexmedetomidine as an adjuvant with lignocaine in preoperative stellate ganglion block for postoperative pain relief following upper limb surgeries.

BACKGROUND: Recent literature has established the role of stellate ganglion block (SGB) for management of acute postoperative pain. The effects of dexmedetomidine as an adjuvant to lignocaine in a preoperative SGB for postoperative pain relief have not been evaluated so far. METHODS: The following randomised, double-blinded, control trail included 54 patients scheduled for upper limb orthopaedic surgery under general anaesthesia. Preoperative ultrasound-guided (USG) SGB was performed in all patients. Group I (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 µg/kg dexmedetomidine for SGB) and 15 mL of intravenous (IV) normal saline (NS). Group II (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 mL NS for SGB) and 15 mL of IV NS. Group III (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 mL of NS for SGB) and 0.5 µg/kg dexmedetomidine in 15 mL of IV NS. Postoperatively tramadol consumption and Visual Analogue Scale (VAS) score were recorded up to 48 hours. RESULTS: The cumulative tramadol consumption at the end of 48 hours (p = 0.01) was significantly reduced in the group I as compared to group II. In group I, postoperative VAS at rest was significantly reduced up to 12 hours postoperatively as compared to group II (p = 0.05). The cumulative tramadol consumption was not reduced significantly in group III compared to group II (p = 0.51). CONCLUSION: Dexmedetomidine as an adjuvant to SGB along with lignocaine produced a significant tramadol sparing effect and superior analgesia as compared to IV dexmedetomidine and control group.1.