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Background and Aims: Pulsed radiofrequency (PRF) of the saphenous nerve (SN) has shown effective pain relief in knee pain because of knee osteoarthritis (KOA). The adductor canal (AC) contains other sensory nerves innervating the medial part of the knee joint apart from SN. We compared the PRF of SN within and outside the AC for their quality and duration of pain relief in knee osteoarthritis of the medial compartment (KOA-MC). Material and Methods: We conducted a randomized prospective study in 60 patients with anteromedial knee pain because of KOA-MC. Patients in group A received PRF-SN, and those in group B received PRF-AC. The primary objectives were comparison of pain by Visual Analog Scale (VAS) scores and changes in quality of daily living by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and OXFORD knee scores. The secondary objectives were comparison of analgesic requirements using Medicine Quantification Scale (MQS) scores and block-related complications. Intra-group comparison was performed by analysis of variance. Inter-group normally distributed data were assessed by Student's t-test, non-normally distributed and ordinal data were assessed by Mann-Whitney U-test, and categorical data were assessed by Chi-square test. A P value of <0.05 was considered significant. Results: VAS scores were significantly lower in Gr-B at 12 weeks. The WOMAC scores and OXFORD scores at 4, 8, 12, and 24 weeks were significantly lower in Gr-B compared to Gr-A. Conclusion: The PRF-AC provides better pain relief and functional outcome than PRF-SN; however, duration of pain relief was not significantly different.
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Background and Aims: Increased pain and associated stiffness hinders the advantages of exercise and process of recovery in primary adhesive capsulitis. We hypothesized that suprascapular nerve block may positively affect the outcome due to its role in pain relief of acute or chronic shoulder pain. We compared the effect of suprascapular nerve block and exercise with only exercise on the recovery of primary adhesive capsulitis. Material and Methods: A total of 96 patients of both sexes presenting with primary adhesive capsulitis were divided by computer randomization in two equal groups (n = 48). Group A received exercise only and Group B received suprascapular nerve block followed by exercise. Oral paracetamol was given for analgesia as desired. Patients were followed up at 4, 8, 16, and 24 weeks. Pain was assessed by visual analog scale; functional outcome by Shoulder Pain and Disability Index and range of movement by goniometer. Results: The pain scores and Shoulder Pain and Disability Index scores were significantly lower at all observation points of 4, 8,16, and 24 weeks in Group B than Group A (P < 0.05). The range of movement in all the ranges of forward flexion, extension, internal and external rotation, and abduction at all observation points was significantly higher in Group-B (P < 0.05) compared to Group A. The consumption of analgesics was significantly more in Group A than Group B at 4 and 8 weeks (P = 0.020 and P = 0.044) but comparable at 12 and 24 weeks (P = 0.145 and P = 0.237 respectively). Conclusion: Combining SSNB with exercise is more effective in treatment of primary adhesive capsulitis than exercise alone and reduces the use of analgesics. SSNB it is effective and safe to use in primary adhesive capsulitis.
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Background and Aims: Truncal blocks play an important role in multimodal analgesia regimens to manage the postoperative pain after lower segment caesarean section (LSCS). This study was aimed to compare the analgesic efficacy of ultrasound (US)-guided transmuscular quadratus lumborum block (TQLB) and thoracic erector spinae plane block (TESPB) in parturients of LSCS done under subarachnoid block (SAB). Methods: In a randomised and double blind study, 60 parturients scheduled for LSCS under spinal anaesthesia were randomly divided into two equal groups: group E (n = 30) and group Q (n = 30). After surgery, each parturient received either US guided bilateral TQLB (group Q) or TESPB (group E) with 20 ml 0.375% ropivacaine and 4 mg dexamethasone on each side. Assessments were done at 2, 4, 6, 8, 10, 12 and 24 h. The primary objective was to compare the duration of analgesia (first request to rescue analgesia) and the secondary objectives were to compare pain scores [numerical rating score (NRS)], total amount of tramadol consumption, incidence of nausea-vomiting, parturient satisfaction and other adverse effects in 24 hours postoperatively. Results: The duration of analgesia (mean ± standard deviation) was comparable in group E (11.90 ± 2.49 h) and group Q (12.56 ± 3.38 h), P = 0.19. Pain scores (NRS) at rest and on movement were comparable at all time points of 2, 4, 6, 8, 10, 12, and 24 h (P > 0.05). The amount of tramadol used was comparable in group E and group Q (P = 0.48). Conclusion: TESPB and TQLB are equally efficacious to provide postoperative analgesia after LSCS done under SAB when used as a part of multimodal analgesia.
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BACKGROUND AND AIMS: Regional analgesic techniques such as supra-inguinal fascia-iliaca compartment block (S-FICB) and pericapsular nerve group (PENG) block have been found to be effective in providing good pain relief in hip-fracture patients. However, comparative studies between PENG and S-FICB are lacking. The aim of this study was to compare the analgesic efficacy of S-FICB and PENG block and assess their efficacy in optimal patient positioning for spinal anaesthesia. METHODS: A prospective randomised double-blind study was conducted in 66 patients randomly divided to receive either S-FICB or PENG block under ultrasound guidance. Primary outcome measures were numerical rating scale (NRS) pain score at rest and on passive 15° limb lifting, 30 minutes after the block and ease of spinal positioning. The secondary outcome measures were NRS over 24 hours, amount of tramadol used (number of rescue doses), patients' satisfaction and block-related complications. The results were analysed using statistical software (MedCalc version 19.2.1). Continuous and categorical data were analysed using appropriate statistical analysis and P < 0.05 was considered significant. RESULTS: Post-block, the NRS score decreased significantly in PENG and S-FICB groups at rest and movement (P < 0.0001). The EOSP score was significantly better in PENG group (P < 0.0001). First analgesic request and pain relief in the first 24-hour period were similar between the groups (P = 0.524). CONCLUSION: PENG block provided better pain relief and ease of positing during SA in patients with fractured hip scheduled for hip surgery.
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BACKGROUND AND AIMS: Transmuscular Quadratus Lumborum Block (TQLB) is a novel regional anaesthesia technique, however, its analgesic efficacy as a component of multimodal analgesia (MMA) in Total Laparoscopic Hysterectomy (TLH) is not well studied. The aim of the study was to evaluate the analgesic efficacy of TQLB as a component of MMA for postoperative pain in TLH. METHODS: A prospective double-blind randomised controlled study was done after approval from the ethical committee and informed patient consent. After randomisation, 37 patients in Group-Q received 20 ml 0.375% ropivacaine and in Group-C, 37 patients received saline in TQLB bilaterally after TLH surgery. All patients received intravenous patient controlled analgesia (IV-PCA) with fentanyl along with diclofenac 75 mg every 12 h. All the patients were assessed at 2, 4, 6, 8, 12, 18, and 24 hours. The primary outcome was the time to first analgesic request. The secondary outcome measures were total fentanyl consumption in 24 hrs, pain scores during rest and movement, postoperative nausea-vomiting, sedation and complications related to local anaesthetic and TQLB procedure. RESULTS: The mean [standard deviation (SD)] time to first analgesic request was 7.8 (1.5) hours in Group-Q and 3.2 (1.0) hours in Group-C (P < 0.0001). The mean (SD) dose of fentanyl used in 24 hours was 167.3 (44) µg in Group-Q and 226.5 (41.9) µg in Group-C (P < 0.0001). CONCLUSION: The ultrasound-guided TQLB provides effective postoperative analgesia after TLH surgery in a multimodal analgesia approach. It reduces the fentanyl consumption and improves the visual analogue scale (VAS) score.
