Publications (11)34.42 Total impact
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Article: Management of complex regional pain syndrome type I in upper extremity-evaluation of continuous stellate ganglion block and continuous infraclavicular brachial plexus block: a pilot study.
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ABSTRACT: Interventional pain management techniques play an important role in the multidisciplinary approach to management of complex regional pain syndrome (CRPS). In this preliminary study we compared the efficacy of continuous stellate ganglion (CSG) block with that of continuous infraclavicular brachial plexus (CIBP) block in management of CRPS type I of upper extremity. Thirty-three patients with CRPS type I of upper extremity were randomly assigned to either CSG or CIBP group. Patients were treated for 1 week with continuous infusion of 0.125% bupivacaine at 2and 5mL/h, respectively. Catheter was removed at 1 week and patients were followed up for 4 weeks. The outcome was evaluated in terms of neuropathic pain scale score (NPSS), edema scores (Grades 0-2), and range of motion (ROM) of all upper extremity joints (Grades 0-2). CIBP group showed statistically significant improvement in NPSS compared with CSG group during the first 12 hours after the procedures (P value <0.05). After 12 hours, the NPSS was comparable between the groups. At 4 weeks, both groups showed clinically significant improvement in edema score and ROM of all upper extremity joints when compared with the baseline. This preliminary study suggests that CIBP block and CSG block may be feasible and effective interventional techniques for the management of CRPS type I of upper extremities. Hence, we recommend a larger well-randomized, well-controlled, clinical trial to confirm our findings and determine if any significant difference exists between the groups in terms of long-term pain relief and functional restoration.Pain Medicine 12/2011; 13(1):96-106. · 2.35 Impact Factor -
Article: Transsacrococcygeal approach to ganglion impar block for management of chronic perineal pain: a prospective observational study.
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ABSTRACT: The ganglion impar or ganglion of Walther is a solitary retroperitoneal structure at the level of sacrococcygeal junction. It provides the nociceptive and sympathetic supply to the perineal structures. Chronic Perineal Pain (CPP) has been effectively managed by ganglion impar block. In this study we analyze the feasibility, safety, and efficacy of ganglion impar block by transsacrococcygeal approach. An observational report. In this prospective study, 16 consecutive patients who required ganglion impar block for CPP were followed for two months. After informed and written consent, the ganglion impar was blocked under aseptic precautions, using a transsacrococcygeal approach. The Visual Analogue Scale for pain (VAS) at presentation time required for the pain to reduce by 50% to be considered effective and VAS was recorded at different time points during 2-month follow-up, and time required to perform the procedure, number of attempts, and any complications were also noted. All the blocks were effective with a mean duration of 12+/-3 minutes for 50% reduction in VAS. The mean duration required to perform the procedure in neurolytic block patients was 7.8+/-2 minutes and 5.7+/-1 minutes in therapeutic block patients. There were no adverse events. All the patients had significant pain relief during 2 month follow-up (p <0.05 compared to baseline). The mean VAS at 2 months was about 2. Statistical analysis was done by using paired "t"/Wilcoxon signed rank test. A transsacrococcygeal approach for a ganglion impar block is a technically feasible and safe technique. We recommend this technique for neurolysis or radiofrequency ablation of the ganglion impar and for diagnostic blocks, especially when the diagnosis and further plan of management is dependent on the response of the diagnostic block.Pain physician 09/2007; 10(5):661-6. · 10.72 Impact Factor -
Article: Massive intraabdominal extravasation of fluid: a life threatening complication following percutaneous nephrolithotomy.
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ABSTRACT: Percutaneous nephrolithotomy provides an attractive alternative to the surgical removal of renal stones as it is associated with reduced patient morbidity and shortened hospital stay. The advantages of this procedure may, however, be overshadowed by complications like bleeding, extravasation of irrigant fluid and infection, which can be life threatening. We report a case of massive extravasation of irrigant fluid producing severe metabolic acidosis, persistent peritonism and ileus leading to a prolonged hospital stay. The patient also required a further surgery for the complete removal of the stones.International Urology and Nephrology 02/2003; 35(3):315-8. · 1.47 Impact Factor -
Article: Massive intraabdominal extravasation of fluid: A life threatening complication following percutaneous nephrolithotomy
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ABSTRACT: Percutaneous nephrolithotomy provides an attractive alternative to the surgical removal of renal stones as it is associated with reduced patient morbidity and shortened hospital stay. The advantages of this procedure may, however, be overshadowed by complications like bleeding, extravasation of irrigant fluid and infection, which can be life threatening. We report a case of massive extravasation of irrigant fluid producing severe metabolic acidosis, persistent peritonism and ileus leading to a prolonged hospital stay. The patient also required a further surgery for the complete removal of the stones.International Urology and Nephrology 01/2003; 35(3):315-318. · 1.47 Impact Factor -
Article: Recurrent adrenal pheochromocytoma: A case report
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ABSTRACT: We report an unusual case of benign recurrent pheochromocytoma that developed at the same site 8 years following initial treatment. This tumor was managed successfully through the 11th rib bed using the transperitoneal extrapleural approach.International Urology and Nephrology 02/2002; 34(1):9-11. · 1.47 Impact Factor -
Article: Recurrent adrenal pheochromocytoma: a case report.
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ABSTRACT: We report an unusual case of benign recurrent pheochromocytoma that developed at the same site 8 years following initial treatment. This tumor was managed successfully through the 11th rib bed using the transperitoneal extrapleural approach.International Urology and Nephrology 02/2002; 34(1):9-11. · 1.47 Impact Factor -
Article: Phenol block in the management of spastic cerebral palsy.
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ABSTRACT: In the present series 116 cases of spastic cerebral palsy were selected; in whom perineal care and ambulation was affected. These cases were given peripheral nerve block (obturator 110, posterior tibial 134 and median nerve 2) with 6% aqueous phenol solution. The block relieved the spastic condition, allowed better nursing care, freed the patient from the embarrassment of a contorted limb, allowed voluntary movement to take place and eased in fitment of caliper to aid further ambulation. The period of effectiveness ranged from 3 months to 18 months, with an average of 13 months. Paraesthesia occurred following 5 nerve blocks. Eleven nerve blocks had to be repeated. Ease, simplicity, safety, therapeutic benefits and economic advantages of peripheral nerve block using phenol in cerebral palsy warrant its more widespread use.The Indian Journal of Pediatrics 04/1994; 61(3):249-55. · 0.52 Impact Factor -
Article: Phantom limb pain during labour.
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ABSTRACT: We report the occurrence of severe phantom limb pain during labour. The patient, a 27-year-old, had had an above knee amputation performed 6 years earlier following a road traffic accident but had no previous history of phantom limb phenomena. However, during early labour, she complained of a severe phantom limb pain in her amputated leg; a continuous epidural block relieved her of the sensation and pain. The sensation did not return following delivery.Anaesthesia 01/1993; 47(12):1053-4. · 2.96 Impact Factor -
Article: Complex regional pain syndrome: a review.
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ABSTRACT: Complex regional pain syndrome (CRPS) is a challenging neuropathic pain state, quite difficult to comprehend and treat. Its pathophysiological mechanisms are unclear and its treatment is difficult. Multiple factors play a role in the generation and maintenance of CRPS. A close interdisciplinary collaboration amongst the psychologist, physical and occupational therapists, neurologist and pain medicine consultants is necessary to achieve optimal treatment effects. The primary goals of managing patients with this syndrome are to: 1) perform a comprehensive diagnostic evaluation, 2) be prompt and aggressive in treatment interventions, 3) assess and reassess the patient's clinical and psychological status, 4) be consistently supportive, and 5) strive for the maximal amount of pain relief and functional improvement. This article reviews the different aspects of CRPS including definition, classification, epidemiology and natural history, clinical presentation, pathophysiology and management.Journal of Postgraduate Medicine 50(4):300-7. · 1.26 Impact Factor -
Article: Role of temporalis muscle over activity in chronic tension type headache: effect of yoga based management.
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ABSTRACT: The role of central versus peripheral mechanisms has always been questioned while explaining the etiopathogenesis of chronic tension type headache (CTTH). The following study was done to study the role of muscle spasm in CTTH. 15 patients of CTTH and 7 age matched controls were included in the study and their m. temporalis EMG was recorded for one minute each during rest, mental activity and maximal voluntary contraction and subjective pain scoring was done by visual analogue scale. The results revealed significant overactivity of m.temporalis in CTTH patients at rest when compared with control subjects (P = 0.01 and 0.03 left and right side respectively). After respective interventions namely non steroidal anti inflammatory drugs, botulinum toxin injections and yogic life style course, the EMG records revealed decrease in the mean EMG amplitude of m. temporalis during rest and mental activity more significantly after yoga based interventions (P = 0.03) and subjective pain scores decreased from 7.00 +/- 2.10 to 2.00 +/- 1.26 (P = 0.02) supporting the beneficial effect of such non invasive techniques.Indian journal of physiology and pharmacology 51(4):333-44. -
Article: Efficacy of intrathecal midazolam with or without epidural methylprednisolone for management of post-herpetic neuralgia involving lumbosacral dermatomes.
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ABSTRACT: Post herpetic neuralgia is a chronic neuropathic pain syndrome which remains one of the most difficult pain disorders to treat. Epidural injection of methylprednisolone with or without local anesthetic provides relief for neuralgia for a short duration only. Recent studies have shown a promising anti nociceptive effect for intrathecal midazolam, a water soluble benzodiazepine, due to its interaction with benzodiazepine-GABA-A receptor complex within the spinal cord. A randomized, double blind study was conducted at 2 different centers in India. Two different interventional pain practice centers in India. To quantify the effectiveness of a single intrathecal injection of midazolam 2 mg with and without epidural methylprednisolone 60 mg for management of pain and allodynia in 150 adult patients with postherpetic neuralgia of 3-6 months duration involving lumbosacral dermatomes. Patients in Group M-0 (n=50) received epidural methylprednisolone (60 mg), patients in group M-1 (n=50) received midazolam 2 mg in the intrathecal space while patients in Group M-2 (n=50) received methylprednisolone (60 mg) in the epidural space plus midazolam 2 mg in the intrathecal space. The administration of intrathecal midazolam (2 mg) provided short term improvement in post herpetic neuralgia similar to epidural methylprednisolone. However, the combination of intrathecal midazolam with epidural methylprednisolone resulted in prolonged duration of analgesia in patients with post herpetic neuralgia. The need for analgesics was also significantly less in patients who received the combination compared to those who received either intrathecal midazolam or epidural methylprednisolone. No serious adverse effect was reported with the use of intrathecal midazolam except a mild degree of sedation. The combination of intrathecal midazolam with epidural methylprednisolone resulted in prolonged duration of analgesia in patients with post herpetic neuralgia of lumbosacral dermatomes due to the complementary anti nociceptive action of intrathecal midazolam with epidural methylprednisolone on spinal nerve roots. The dose-response relationship of intrathecal midazolam was not evaluated in our study, so further study should be conducted with different doses of intrathecal midazolam for management of PHN.Pain physician 13(3):213-21. · 10.72 Impact Factor
Top co-authors
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Institutions
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2011
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Detroit Medical Center
- Division of Anesthesiology
Detroit, MI, USA
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1993–2002
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All India Institute of Medical Sciences
- • Department of Urology
- • Department of Anaesthesiology
New Delhi, NCT, India
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