Evaluation of new approach to ultrasound guided stellate ganglion block

Background: Ultrasound imaging is an ideal tool for stellate ganglion block (SGB) due to clarity, portability, lack of radiation, and low cost. Ultrasound guided anterior approach requires the application of pressure to the anterior neck and is associated with more risk of injury to inferior thyroid artery, vertebral artery, and esophagus. The lateral approach does not interfere with nerve or vascular structures. Blockade at the C 6 vertebral level results in more successful sympathetic blockade of the head and neck with less sympathetic blockade of the upper extremity compared to sympathetic blockade at C 7 vertebral level, which produces successful sympathetic blockade of upper extremity. This is helpful in patients of complex regional pain syndrome of the upper limb. Hence, we conducted a study using the lateral approach at C 7 level. Materials and Methods: Ultrasound guided SGBs using lateral in-plane technique at C 7 level were given in 20 patients suffering from chronic pain patients of upper extremity, head, and neck using 4 ml of 0.25% bupivacaine and 1 ml of 40 mg triamcinolone. The patients were assessed for a numeric pain intensity score (NPIS), the rise in axillary temperature, the range of motion of joints of upper extremity, and resolution of edema at various time intervals up to 3 months. Results: NPIS showed a statistically significant decrease from baseline at 30 min, which was sustained till 3 rd month. The rise in axillary temperature after the block was statistically significant, which was sustained till 2 nd week. The edema score decreased significantly at all-time intervals (P ≤ 0.001). The restriction of motion in all joints of upper limb decreased from 13 to 3 patients. Conclusion: There is a significant variation in the anatomy of stellate ganglion at the level of C 6 and C 7 . Ultrasound guided lateral approach increases the efficacy of SGB by deposition of drug subfascially with real-time imaging

Evaluation of new approach to ultrasound guided stellate ganglion block

Background: Ultrasound imaging is an ideal tool for stellate ganglion block (SGB) due to clarity, portability, lack of radiation, and low cost. Ultrasound guided anterior approach requires the application of pressure to the anterior neck and is associated with more risk of injury to inferior thyroid artery, vertebral artery, and esophagus. The lateral approach does not interfere with nerve or vascular structures. Blockade at the C 6 vertebral level results in more successful sympathetic blockade of the head and neck with less sympathetic blockade of the upper extremity compared to sympathetic blockade at C 7 vertebral level, which produces successful sympathetic blockade of upper extremity. This is helpful in patients of complex regional pain syndrome of the upper limb. Hence, we conducted a study using the lateral approach at C 7 level. Materials and Methods: Ultrasound guided SGBs using lateral in-plane technique at C 7 level were given in 20 patients suffering from chronic pain patients of upper extremity, head, and neck using 4 ml of 0.25% bupivacaine and 1 ml of 40 mg triamcinolone. The patients were assessed for a numeric pain intensity score (NPIS), the rise in axillary temperature, the range of motion of joints of upper extremity, and resolution of edema at various time intervals up to 3 months. Results: NPIS showed a statistically significant decrease from baseline at 30 min, which was sustained till 3 rd month. The rise in axillary temperature after the block was statistically significant, which was sustained till 2 nd week. The edema score decreased significantly at all-time intervals (P ≤ 0.001). The restriction of motion in all joints of upper limb decreased from 13 to 3 patients. Conclusion: There is a significant variation in the anatomy of stellate ganglion at the level of C 6 and C 7 . Ultrasound guided lateral approach increases the efficacy of SGB by deposition of drug subfascially with real-time imaging

Isolated frontal sinus aspergillosis – Presenting as ‘Pott’s puffy tumor’

Isolated frontal sinus aspergillosis is extremely uncommon. Frontal sinus is commonly involved secondarily in association with other sinuses. A case of isolated frontal sinus aspergillosis is being reported which presented as Pott’s puffy tumor. Frontal sinus exploration was done under general anesthesia. A small focus of the osteomyelitic bone in the anterior wall of the frontal sinus was removed. The fungus ball filling the left frontal sinus was removed

A randomized controlled trial to compare pregabalin with gabapentin for postoperative pain in abdominal hysterectomy

Background: Pregabalin is a potent ligand for alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system, which exhibits potent anticonvulsant, analgesic and anxiolytic activity. The pharmacological activity of pregabalin is similar to that of gabapentin and shows possible advantages. Although it shows analgesic efficacy against neuropathic pain, very limited evidence supports its postoperative analgesic efficacy. We investigated its analgesic efficacy in patients experiencing acute pain after abdominal hysterectomy and compared it with gabapentin and placebo. Methods: A randomized, double-blind, placebo-controlled study was conducted in 90 women undergoing abdominal hysterectomy who were anaesthetized in a standardized fashion. Patients received 300 mg pregabalin, 900 mg gabapentin or placebo, 1-2 hours prior to surgery. Postoperative analgesia was administered at visual analogue scale (VAS) ≥3. The primary outcome was analgesic consumption over 24 hours and patients were followed for pain scores, time to rescue analgesia and side effects as secondary outcomes. Results: The diclofenac consumption was statistically significant between pregabalin and control groups, and gabapentin and control groups; however, pregabalin and gabapentin groups were comparable. Moreover, the consumption of tramadol was statistically significant among all the groups. Patients in pregabalin and gabapentin groups had lower pain scores in the initial hour of recovery. However, pain scores were subsequently similar in all the groups. Time to first request for analgesia was longer in pregabalin group followed by gabapentin and control groups. Conclusion: A single dose of 300 mg pregabalin given 1-2 hours prior to surgery is superior to 900 mg gabapentin and placebo after abdominal hysterectomy. Both the drugs are better than placebo

A Peripheral Primitive Neuro-ectodermal Tumor (pPNET) of Larynx

Introduction Primitive neuroectodermal tumors (PNETs) are malignant tumors comprised of small round cells of neuro-ectodermal origin that affect soft tissue and bone. Though the occurrence of pPNETs in the head and neck region is rare, these are aggressive malignant tumors, and long-term survival rates following diagnosis remain poor. Case Report In the present case, a tumour was located in larynx (as globular/cystic mass of epiglottis) of the patient and was diagnosed as pPNET. Immunohistochemical analysis indicated that tumor cells were positive for CD99 and NSE, focally positive for EMA but negative for synaptophysin and chromogranin. The mass was surgically excised with negative margins. In post op period patient was planned for post-op chemotherapy and radiotherapy. Conclusion pPNETs are very rare in head and neck region. Significant advances in the neoadjuvant and adjuvant chemotherapeutic regimens, as well as improved facility in diagnosing these tumors through cytogenetic and immunohistochemical analysis improves the long-term disease-free survival

A Peripheral Primitive Neuro-ectodermal Tumor (pPNET) of Larynx

Introduction Primitive neuroectodermal tumors (PNETs) are malignant tumors comprised of small round cells of neuro-ectodermal origin that affect soft tissue and bone. Though the occurrence of pPNETs in the head and neck region is rare, these are aggressive malignant tumors, and long-term survival rates following diagnosis remain poor. Case Report In the present case, a tumour was located in larynx (as globular/cystic mass of epiglottis) of the patient and was diagnosed as pPNET. Immunohistochemical analysis indicated that tumor cells were positive for CD99 and NSE, focally positive for EMA but negative for synaptophysin and chromogranin. The mass was surgically excised with negative margins. In post op period patient was planned for post-op chemotherapy and radiotherapy. Conclusion pPNETs are very rare in head and neck region. Significant advances in the neoadjuvant and adjuvant chemotherapeutic regimens, as well as improved facility in diagnosing these tumors through cytogenetic and immunohistochemical analysis improves the long-term disease-free survival