Use of Pregabalin as Preemptive Analgesia for Decreasing Postoperative Pain in Tympanoplasty.

Tympanoplasty is a commonly performed surgical procedure done by Otorhinolaryngologist for treatment of chronic suppurative otitis media. Postoperative period requires the use of analgesics which are given regularly. The study aims to assess the efficacy of a single dose of preemptive pregabalin in decreasing postoperative pain after postauricular type 1 tympanoplasty. This randomized prospective study was carried out in a tertiary care hospital between July 2017 and April 2018. A total of 60 patients were divided into two groups of 30 each. This study analyzed the effect of single preoperative use of pregabalin 150 mg oral 1 h before type 1 postauricular tympanoplasty for postoperative pain as a VAS (visual analogue scale) score and requirement of rescue analgesia and results were compared with the placebo group. Pain scores (VAS score) was significantly lower in the pregabalin group as compared to the placebo group at 6, 12, 24, and at 48 h. Rescue analgesia requirements were also lower in the pregabalin group than the placebo group. Preemptive use of a single dose of oral 150 mg pregabalin reduces postoperative pain and rescue analgesic requirement in patients undergoing type 1 tympanoplasty.

Clinical Analysis of Propofol, Etomidate and an Admixture of Etomidate and Propofol for Induction of General Anaesthesia.

OBJECTIVE: To compare the clinical outcome following induction of general anaesthesia with intravenous (IV) injection of propofol (P), etomidate (E) or a 50% admixture of propofol and etomidate (PE). METHODS: In this prospective, randomised, double-blind controlled study, patients 18-60 years of age who were undergoing elective surgery with general anaesthesia were randomised to receive either propofol 2.5 mg kg-1 IV (group P; n=30), etomidate 0.3 mg kg-1 IV (group E; n=30) or an admixture of etomidate 0.2 mg kg-1 IV and propofol 1 mg kg-1 IV (group PE; n=30) as the induction agent. The haemodynamic response was first recorded at baseline, then at 1 minute following administration the study drug, and 1, 3, 5, 10, 20, 30 and 40 minutes following intubation. Perioperative symptoms such as myoclonus, pain upon injection and/or vomiting upon induction as well as postoperative nausea were recorded. RESULTS: We observed a decrease in systemic haemodynamics from baseline following induction in group P compared to groups E and PE (p<0.05). Incidence of myoclonus was reduced from 76.6% in group E to 6.6% in group PE (p<0.001). There was also a reduction in reported pain upon injection in group PE compared to group P (p<0.001). Although we found no statistically significant difference between the three groups when assessing postoperative nausea and vomiting, these symptoms were more prevalent in groups E and PE than in group P. CONCLUSION: Using an admixture of etomidate and propofol as the induction agent reduced the incidence of side effects observed with use of either drug alone such as pain upon injection, myoclonus and haemodynamic instability.

A study of the efficacy of stellate ganglion blocks in complex regional pain syndromes of the upper body.

BACKGROUND AND AIMS: The effect of stellate ganglion blocks (SGBs) was examined in complex regional pain syndromes (CRPS) of the upper body. MATERIAL AND METHODS: A total of 287 SGB were given to patients with documented CRPS on medications. Spontaneous and provoked pain assessment was done with numeric pain rating scale (NPRS). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and range of motion (ROM) was recorded before and after each blockade. Difference between a 15-point "global rating of change" scale determined the minimal clinically important difference of the DASH score. RESULTS: The overall mean pain reduction was 73.2% (r = 0.83, P < 0.001) considering spontaneous and 55.8% (r = 0.77, P < 0.001) on provoked pain. Mean DASH score decreased from 53 (range 36-63; P = 0.14) to 10.4 (range 10-49.2; P = 0.005). The sensitivity to change was 6.9 for spontaneous and 4.9 for provoked pain. Increase in ipsilateral limb temperature has a good correlation with Horner's syndrome (HS) and sympathetic blockade. Minor, self-limiting complications, such as hoarseness, dysphagia, local hematoma, and ipsilateral brachial plexus block occurred in 11.5%. A rare complication of contralateral HS was documented. One patient developed a small pneumothorax, but it did not require intervention. CONCLUSIONS: SGB are relatively safe and effective management in patients with neuropathic conditions already on pharmacotherapy. Serial blocks attained an average reduction in pain by >3 NPRS points from the baseline for both spontaneous and provoked pain with a decrease in mean DASH score and improvement in ROM.

Keratoacanthoma centrifugum marginatum: unresponsive to oral retinoid and successfully treated with wide local excision.

We describe a case of a 65-year-old male presenting with a large plaque with a rolled-out interrupted margin, atrophic center, and island of normal skin over the left arm. It grew peripherally with central healing, and there was a history of recurrence after inadequate excision. Investigations ruled out other clinical mimickers; namely, squamous cell carcinoma, lupus vulgaris, botryomycosis, and blastomycosis-like pyoderma. Histopathological sections showed irregularly shaped craters filled with keratin and epithelial pearl but no evidence of granuloma or cellular atypia. Clinicopathological correlation proved the lesion to be keratoacanthoma centrifugum marginatum (KCM), a rare variant of keratoacanthoma, which spreads centrifugally, attains a huge size, and never involutes spontaneously. Treatment of KCM has been a problem always and, in our case, systemic retinoid (acitretin for three months) proved ineffective. The patient also had a history of recurrence following surgical intervention previously, necessitating wide excision to achieve complete clearance of tumor cells. Hence, after failure of retinoid therapy, the decision of excision with a 1-centimeter margin was taken and the large defect was closed by a split thickness skin graft. The graft uptake was satisfactory, and the patient is being followed-up presently and shows no signs of recurrence after six months, highlighting wide local excision as a useful treatment option.