ABS0110
Pain relief and functional outcome after fluoroscopic guided intraarticular sacroiliac joint injection of 1ml 1% lignocaine with 1ml 40 mg triamcinolone acetonide in sacroiliitis
Priyanka Sahu, Renu Dhamnani, Roopesh Jain, Nupur Chakravarty
L.N.Medical College and J.K.Hospital, Bhopal
Email: priyankasahu111@gmail.com
Background and Aims: Low back pain is a widespread health problem. Fluoroscopically guided diagnostic and therapeutic intra-articular sacroiliac joint injections are often used to treat low back pain.[1,2] This study aimed to assess pain relief and functional outcome after fluoroscopic guided intraarticular sacroiliac joint injection of 1 ml 1% lignocaine with 1 ml 40 mg triamcinolone acetonide in diagnosed cases.
Methods: A total of 139 adult patients were taken for the study. The severity of pain and functional disability due to pain were assessed by numeric rating scale (NRS) and Oswestry disability index (ODI), respectively. The severity of pain and functional disability due to pain were assessed before the pain intervention procedure, immediately after the procedure, at two weeks, four weeks and three months after the procedure.
Results: This study observed that fluoroscopic guided intraarticular sacroiliac joint injection of 1 ml 1% lignocaine with 1 ml 40 mg triamcinolone acetonide is associated with improved pain scores. The pain scores showed significant improvement at all time points compared to pre-procedural scores.
Conclusion: Fluoroscopic guided intra-articular sacroiliac joint injection can be an effective treatment option for patients diagnosed with sacroiliitis, receiving medical treatment for low backache without relief.
Keywords: Intraarticular injection, pain management, sacroiliitis
References:
1. Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol 2010; 24:769-81.
2. Kennedy DJ, Engel A, Kreiner DS, Nampiaparampil D, Duszynski B, MacVicar J. Fluoroscopically guided diagnostic and therapeutic intra-articular sacroiliac joint injections: A systematic review. Pain Med 2015; 16:1500–18.
ABS1104
Comparative evaluation of two different doses of corticosteroid with local anaesthetic for suprascapular nerve block in patients with cervical radicular pain: A prospective study
Deepika Budhwar, Rishab Anand, Naveen Malhotra, Amit Rana
Pt. BD Sharma PGIMS, Rohtak
Email: deepikabudhwar212@gmail.com
Background and Aims: Neck pain from various cervical spine disorders is the leading cause of musculoskeletal disorders. This prospective study compared the efficacy of suprascapular nerve block using local anaesthetic and two different doses of dexamethasone in cervical radicular pain.
Methods: Forty participants were randomised to group I (n=20) or group II (n=20). In group I, patients received anatomical landmark-guided suprascapular nerve block with a 6ml drug solution comprising 0.25% bupivacaine (4ml) plus 8 mg of dexamethasone (2ml). In group II, patients received anatomical landmark-guided suprascapular nerve block with a 6ml drug solution comprising 0.25% bupivacaine (4ml) plus 8 mg of dexamethasone (2ml) plus normal saline (1ml). Two patients were followed up for three months. Numerical rating scale (NRS), patient global impression of change (PGIC), need for repeat injections and procedural complications were compared between the groups.
Results: NRS and PGIC scores were to be comparable between the two groups at all the time intervals (Figure 1) (P>0.05). The two groups had no significant difference regarding the number of repeat injections (P>0.05). None of the patients reported any severe complications.
Figure 1.
Numerical rating scale (NRS) scores with two different doses of corticosteroids
Conclusion: Both suprascapular nerve blocks with local anaesthetic plus 8 mg and 4 mg of dexamethasone are safe and practical techniques for the management of patients with cervical radicular pain. Hence, suprascapular nerve block with 4 mg dexamethasone can be utilised to reduce steroid-related side effects and improve the cost-effectiveness of the treatment without compromising on the efficacy and safety of the therapy in patients with cervical radicular pain.
Keywords: Cervical radiculopathy, dexamethasone, suprascapular nerve block
References:
1. James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study. Lancet 2018; 10:1789-858.
2. Liu J, Richman KA, Grodofsky SR, Bhatt S, Huffman GR, Kelly JD IV et al. Is there a dose-response of dexamethasone as an adjuvant for supraclavicular brachial plexus nerve block? A prospective randomised double-blinded clinical study. J Clin Anaesth 2015; 27:237-42.
ABS0277
Efficacy of pulsed radio frequency of dorsal root ganglion combined with transforaminal epidural steroid injections and transforaminal epidural steroid alone for chronic lumbosacral radicular pain: A comparative study.
Aishwarya Nadagouda, Pratibha R Matche
JSS Hospital and Medical College, Mysore
Email: aishwaryanadgouda@gmail.com
Background and Aims: Chronic lumbosacral radicular pain is a significant public health issue worldwide.[1,2] The objective of this study was to compare the efficacy of pulsed radio frequency (PRF) of dorsal root ganglion (DRG) with transforaminal epidural steroid injections (TFESI) with TFESI alone for chronic lumbosacral radicular (CLR) pain and to compare the outcomes using parameters during follow-up intervals.
Methods: Twenty patients were selected and randomised into two groups, with ten patients each. Groups were divided depending on the interventional pain procedure under fluoroscopy and dye guidance in the prone position. Group T underwent TFESI. Group TR underwent DRG PRF and TFESI. All patients were assessed for the intensity of pain on a scale of 0-10 by NRS scale and functional status by modified Oswestry disability index (ODI) and patient satisfaction through the GPI index assessed at pre-procedure, immediate post-procedure and follow-up intervals of 2, 4, 12 weeks.
Results: All baseline variables were compared between the two groups. The reduction in NRI scoring and ODI index is seen more in group TR compared to group T in all time intervals, and it was statistically insignificant (P>0.05) at all time intervals. Group TR showed higher values than group T in the GPI index in all intervals but was statistically significant only at 12 weeks (P < 0.05). There was no incidence of surgery or any complications.
Conclusion: DRG PRF and TFESI are safe and effective techniques for managing CLR, with good outcomes and patient satisfaction.
Keywords: Epidural, pulsed radio frequency, steroid, transforaminal injection
References:
1. De M, Mohan VK, Bhoi D, Talawar P, Kumar A, Garg B, et al. Transforaminal epidural injection of local anaesthetic and dorsal root ganglion pulsed radiofrequency treatment in lumbar radicular pain: a randomised, triple-blind, active-control trial. Pain Pract 2020;20:154-167.
2. Shanthanna H, Chan P, McChesney J, Thabane L, Paul J. Pulsed radiofrequency treatment of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain: a randomised, placebo-controlled pilot study. J Pain Res 2014;7:47-55.
ABS1102
Comparative evaluation of the efficacy of platelet-rich plasma injection with a combination of local anaesthetic and steroid in plantar fasciitis: A prospective study
Neha Sinha, Arun, Naveen Malhotra, Amit Kumar
PGIMS, Rohtak
Email: dr.nehasinha01@gmail.com
Background and Aims: Plantar fasciitis (PF) is a localised inflammation and degeneration of the plantar aponeuroses commonly presenting as heel pain.[1,2] We compared the efficacy of injection of platelet-rich plasma with a combination of local anaesthetic and steroid in patients with PF.
Methods: Fifty patients of < 20 years diagnosed with PF who failed to respond to six weeks of conservative treatment were in two groups of 25 each: Group-I patients were administered fluoroscope-guided injection of 2ml 0.5 % bupivacaine and 1 ml of triamcinolone (40 mg) and group II patients were administered fluoroscope guided injection of 3ml platelet-rich plasma. Outcome assessment was done by evaluating pain score using the numeric rating scale (NRS, 0-10), functional disability using the foot and ankle disability index (FADI), patient satisfaction and side effects.
Results: Demographic variables were comparable in both groups. There was a significant improvement in NRS and FADI after injection in both groups at all-time intervals (P<0.05). Significantly lower pain scores and FADI were observed at the half hour, two weeks, and one month in group I, while three months were observed in group II. FADI was significantly better in group I until one month after injection while at three months in group II (p<.001)
Conclusion: Fluoroscope-guided injections of corticosteroids with bupivacaine and platelet-rich plasma are safe and effective techniques for managing symptomatic PF. Both these techniques provide good pain relief and improve physical disability; however, the injection of platelet-rich plasma provides a sustained and more prolonged improvement.
Keywords: Corticosteroid, plantar fasciitis, platelet-rich plasma
References:
1. Peerbooms JC, Lodder P, den Oudsten BL, Doorgeest K, Schuller HM, Gosens T. Positive effects of platelet-rich plasma on pain in plantar fasciitis. Am J Sports Med 2019; 47:3238-46.
2. Reddy RM, Kumar AV, Shaik T, Rudra S. The role of PRP injection in managing plantar fasciitis: The analytical prospective study in 60 patients. Nat J Clin Orthop 2019; 3:100-4.
ABS0638
Effect of anaesthetic technique on chronic pain in patients undergoing breast cancer surgery: Follow-up data from a randomised controlled trial
Riniki Sarma, Nishkarsh Gupta, Seema Mishra, Sushma Bhatnagar
All India Institute of Medical Sciences, Delhi
Email: rinikirs@gmail.com
Background and Aims: Our study aimed to assess the efficacy of opioid anaesthesia (OFA) versus opioid-based anaesthesia in the perioperative period and the development of chronic pain in the follow-up period in patients undergoing breast cancer surgery.
Methods: One hundred patients undergoing breast cancer surgery were randomised into two groups in a 1:1 ratio (Trial registered in Clinical Trials Registry-India: CTRI/2019/08/020865). Group O received opioid-based anaesthesia, and Group N did not receive any opioids intraoperatively. Postoperatively, analgesia was managed with a patient-controlled analgesia pump containing morphine in both groups. Our primary outcome was 24-hour morphine consumption. Secondary outcomes included numerical rating scale (NRS) at various time points postoperatively (1,2,6,24 h) and at 6 months along with inflammatory markers [neutrophil lymphocyte ratio (NLR), natural killer cells (NKCs), T helper cells and cytotoxic T cells].
Results: There was no statistical difference in the total 24-hour postoperative morphine consumption (P = 0.13). The NRS score at 6 months differed significantly, with group N having a lower score as mean (SD) 4.72(2.2) versus 2.56(1.41); P < 0.05. NRS at rest and on movement at various time points postoperatively did not differ significantly, P > 0.05 [Figure 1]. There was a significant difference in NLR between the two groups at 24 hours post-surgery, P=0.03.
Figure 1.
Box and whisker plot showing the numerical rating scale (NRS) scores at six months postoperatively in groups O and N. The inner vertical line represents the median morphine consumption.
Conclusion: Our follow-up data showed that OFA is associated with decreased chronic pain at 6 months and can be considered as a technique of choice in oncosurgeries as it is equally productive and causes lesser immunosuppression than opioid-based technique.
Keywords: Analgesics, breast cancer, opioid, regional anaesthesia
References:
1. Gärtner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA 2009;302: 1985–92.
2. Mulier J. Opioid-free general anaesthesia: A paradigm shift? Rev Esp Anestesiol Reanim 2017;64: 427–30.
ABS0794
Comparison of anterior and posterior approach of suprascapular nerve block with pulsed radiofrequency neuromodulation for pain relief in patients with adhesive capsulitis: A randomised controlled study.
Nitin Kumar, Akhilesh Gupta, M.D. Kaur
ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi
Email: nitinkumar737@gmail.com
Background and Aims: Suprascapular nerve block has become an effective treatment in frozen shoulder patients. We aimed to compare the anterior and posterior approach of ultrasound-guided suprascapular nerve block with pulsed radiofrequency neuromodulation for pain relief in adhesive capsulitis.
Methods: We randomly allocated 60 patients in two groups of 30 each in the study, group A - anterior and group B - posterior approaches. Tracing of the suprascapular nerve through ultrasound guidance was done in both approaches. Visualisation of nerve and depth from skin to nerve was measured. The appropriate location for the electrode was confirmed by both sensory and motor stimulation. The primary outcome was the numeric rating score (NRS), and the secondary outcome was the shoulder pain and disability index (SPADI), visualisation and depth of nerve from the skin. NRS and SPADI have a follow-up of 3 months
Results: NRS and SPADI values in both the approaches (anterior and posterior) show a declining trend from pre-procedure to the third-month follow-up [Figure 1, Table 1]. Both had a P value < 0.001 between pre-procedure and third-month follow-up, which is statistically significant at P<0.05. The overall decline in the mean NRS scores and mean total SPADI values is more in the anterior approach than the posterior approach but is statistically insignificant.
Figure 1.
Comparison of total shoulder pain and disability index (SPADI) values of the anterior approach group with the posterior approach group at the same point in time
Table 1.
Comparison of numerical rating scale (NRS) values of the anterior approach group with the posterior approach group at the same point in time
| NRS | Anterior | Posterior | P |
|---|---|---|---|
| Post-procedure | 2.83 (1.21) | 3.03 (1.33) | 0.54 |
| 1st-week follow-up | 2.90 (1.21) | 2.73 (1.05) | 0.57 |
| 1st-month follow-up | 1.3 (0.70) | 1.40 (0.67) | 0.58 |
| 2nd-month follow-up | 0.93 (0.69) | 1.1 (0.71) | 0.36 |
| 3rd-month follow-up | 0.80 (0.80) | 0.90 (0.80) | 0.63 |
Data represented as mean (standard deviation)
Conclusion: Both approaches are practical, and the outcome achieved via the anterior versus posterior approach is not statistically significant. However, better visualisation, less nerve depth and ease of doing by the clinician are some factors advocating for the anterior approach to be the more desirable.
Keywords: Pulsed radiofrequency neuromodulation, shoulder pain, suprascapular nerve block
References:
1. Ergönenç T, Beyaz SG. Effects of ultrasound-guided suprascapular nerve pulsed radiofrequency on chronic shoulder pain. Med Ultrason 2018; 20:461-6.
2. Liliang PC, Lu K, Liang CL, Tsai YD, Hsieh CH, Chen HJ. Pulsed radiofrequency lesioning of the suprascapular nerve for chronic shoulder pain: a preliminary report. Pain Med 2009; 10:70-5.
ABS0816
Genicular nerve block in osteoarthritis - do we need to block all four nerves?
S Geethavarshini, Parthasarathy S
Mahatma Gandhi Medical College, Pondicherry
Email: geethavarshinisen@gmail.com
Background and Aims: Genicular nerve blocks are minimally invasive procedures to relieve pain in people with knee osteoarthritis. There are four genicular nerves: supero-lateral, superomedial, infero-lateral and infero-medial. These injections offer an option for treating knee pain without motor power loss.[1,2]
Methods: This report of two cases with severe osteoarthritis on the right side had a visual analogue scale (VAS) score 8/10. These patients were given 5 ml of an equal combination of 0.25 % bupivacaine with absolute alcohol, targeting three out of the four nerves, leaving alone the infero lateral branches. This nerve was left because of its close association with the common peroneal (CP) nerve. Any block of the CP nerve may cause a motor block, likely affecting the functional outcome. The patients were assessed immediately after fifteen days and every month for three months.
Results: The VAS scores came down to 2/10 immediately in a few minutes and maintained at around 4/10 even after three months. There were no side effects.
Conclusion: We conclude that targeting three of the four described nerves is sufficient for adequate analgesia in patients with osteoarthritis with severe pain.
Keywords: Common peroneal nerve, genicular nerve block, osteoarthritis
References:
1. Shanahan EM, Robinson L, Lyne S, Woodman R, Cai F, Dissanayake K, et al. Genicular Nerve Block for Pain Management in Patients with Knee Osteoarthritis: A Randomized Placebo-Controlled Trial. Arthritis Rheumatol 2023; 75:201-209.
2. Tran J, Peng PWH, Lam K, Baig E, Agur AMR, Gofeld M. Anatomical Study of the Innervation of Anterior Knee Joint Capsule: Implication for Image-Guided Intervention. Reg Anesth Pain Med 2018; 43:407-14.
ABS1106
Comparison of efficacy of intraarticular injection of platelet-rich plasma or bupivacaine and steroid combination in chronic shoulder pain: A prospective randomised study.
Disha Gupta, Ritu Rathee, Naveen Malhotra, Amit Kumar
Pt. BD Sharma PGIMS, Rohtak
Email: disha3286@gmail.com
Background and Aims: Shoulder pain is progressive and associated with loss of mobility in the glenohumeral joint. Treatment aims to relieve symptoms, improve joint mobility and function, and optimise the quality of life.[1,2]
Methods: Fifty patients with pain patterns consistent with shoulder pathology and not responding to six weeks of conservative treatment were randomised to receive anatomic landmark-guided injections of 3 ml 0.5 % bupivacaine and 1 ml of triamcinolone (40 mg) in group I and 4 ml platelet-rich plasma in group II. Outcome assessment was done with pain score evaluation using the numeric rating scale (NRS), shoulder pain and disability index (SPADI), patient satisfaction and side effects.
Results: There was significant improvement in NRS after injection in both groups at all time intervals (P < 0.05) [Figure 1]. Significantly lower pain scores were observed at half an hour, two weeks and one month in group I while at 2 and 3 months in group II. Better patient satisfaction was observed in group II. SPADI was statistically comparable at all time intervals except at half an hour and two weeks after injection.
Figure 1.
Comparison of pain scores (numeric rating scale) in the two Groups
Conclusion: Intraarticular injection of corticosteroids with bupivacaine and platelet-rich plasma are safe and effective techniques for the management of chronic shoulder pain in terms of pain relief and improvement in physical disability. Intraarticular injection of platelet-rich plasma provides sustained and more prolonged improvement.
Keywords: Chronic shoulder pain, intraarticular, platelet-rich plasma
References:
1. Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: part I: evaluation and diagnosis. Am Fam Phys 2008; 77:4- 11.
2. Kothari SY, Srikumar V, Singh N. Comparative efficacy of platelet-rich plasma injection, corticosteroid injection and ultrasonic therapy in treating peri arthritis shoulder. J Clin Diagn Res 2017; 11:15-8.