Objective Discogenic pain is common cause of low back ache and may result in significant morbidit... more Objective Discogenic pain is common cause of low back ache and may result in significant morbidity. Platelet-rich plasma (PRP) is an upcoming regenerative therapy that has treatment potential for this condition. The objective of this study was to correlate platelet concentration in intradiscal PRP injection with improvement in low back pain and functional status at three and six months. Design Prospective single-arm interventional study. Setting Outpatient pain clinic and operation theater. Subjects Twenty-five patients with discogenic pain diagnosed by clinical means and imaging with confirmation by provocative discography were recruited. Methods The patients received PRP injection at a single or multiple disc levels. Preprocedure numerical rating scale (NRS) pain scores and Oswestry Disability Index (ODI) scores were calculated. Platelet counts of patients and PRP samples were measured. At three and six months postprocedure, NRS and ODI scores were measured, and improvement in the...
Propofol and isoflurane have well proven roles as intravenous and inhalational anaesthetics respe... more Propofol and isoflurane have well proven roles as intravenous and inhalational anaesthetics respectively in neurosurgery. We conducted this study to know the outcome using butorphanol as an intraoperative analgesic. Sixty craniotomy patients randomly divided into two groups of 30 each were included in this study. Group A patients were induced and maintained with propofol. Group B patients were induced with thiopentone and maintained with isoflurane. All patients were administered 30mug.kg(-1) butorphanol intravenously 10 minutes before induction of anaesthesia, followed by slow injection of 30mug.kg(-1) midazolam. All were assessed for sedation, respiratory insufficiency, postoperative nausea and vomiting (PONV) and other side effects in the recovery room. We found no difference in demographic parameters between the groups. The fall in HR was maintained in the post induction / intubation period and throughout the intraoperative period in Group A, unlike Group B patients in whom it r...
Background: A variety of minimally invasive techniques (chemonucleolysis, laser, automated percut... more Background: A variety of minimally invasive techniques (chemonucleolysis, laser, automated percutaneous discectomy, percutaneous manual nucleotomy) have been invented over the years, as treatment of low back pain related to disc disease. Automated percutaneous lumbar dissectomy (APLD), being one of these techniques, is a modality in which removal of nucleus pulposus, reduces intradiscal pressure thus relieves the nerve root compression and subsequently reduces radicular pain. This technique was introduced by Onik in 1985, referred to as ‘automated’ since it involves a mechanical probe, working by a ‘suction and cutting action for removal of the nucleus pulposus. Methodology: After meeting the inclusion criteria, minimal invasive procedure – APLD, performed in between 2012 to 2015 on 120 patients on outdoor basis. Radicular discogenic pain was confirmed by MRI and clinical finding, procedure is being performed using nucleotome under fluoroscopic guidance. Result: Based on patient sat...
Severe cardiovascular responses in the form of tachycardia and hypertension following nasal specu... more Severe cardiovascular responses in the form of tachycardia and hypertension following nasal speculum insertion occur during sublabial rhinoseptal trans-sphenoid approach for resection of small pituitary tumours. We compare the effects of preoperative administration of clonidine (α-2 agonist) and atenolol (α-blocker) over haemodynamic response, caused by speculum insertion during trans-sphenoid pituitary resection. We enrolled 66 patients in age range 18-65 years, of ASA I-II, and of either sex undergoing elective sublabial rhinoseptal trans-sphenoidal hypophysectomy. Group I (control) received placebo, group II (clonidine) received tablet clonidine 5 µg/kg, and group III (atenolol) received tablet atenolol 0.5 mg/kg. The heart rate increased on speculum insertion and 5 and 10 minutes following speculum insertion as compared to the pre-speculum values in the control group, while no change in the heart rate was observed in other groups (P<0.05). There was a rise in the mean arterial pressure during and 5, 10, and 15 minutes after nasal speculum insertion in the control group, whereas it was not seen in other groups (P<0.05). We therefore suggest that oral clonidine and oral atenolol (given 2 hours prior to surgery) is an equally effective and safe method of attenuating haemodynamic response caused by nasal speculum insertion during trans-sphenoid pituitary resection.
Objective Discogenic pain is common cause of low back ache and may result in significant morbidit... more Objective Discogenic pain is common cause of low back ache and may result in significant morbidity. Platelet-rich plasma (PRP) is an upcoming regenerative therapy that has treatment potential for this condition. The objective of this study was to correlate platelet concentration in intradiscal PRP injection with improvement in low back pain and functional status at three and six months. Design Prospective single-arm interventional study. Setting Outpatient pain clinic and operation theater. Subjects Twenty-five patients with discogenic pain diagnosed by clinical means and imaging with confirmation by provocative discography were recruited. Methods The patients received PRP injection at a single or multiple disc levels. Preprocedure numerical rating scale (NRS) pain scores and Oswestry Disability Index (ODI) scores were calculated. Platelet counts of patients and PRP samples were measured. At three and six months postprocedure, NRS and ODI scores were measured, and improvement in the...
Propofol and isoflurane have well proven roles as intravenous and inhalational anaesthetics respe... more Propofol and isoflurane have well proven roles as intravenous and inhalational anaesthetics respectively in neurosurgery. We conducted this study to know the outcome using butorphanol as an intraoperative analgesic. Sixty craniotomy patients randomly divided into two groups of 30 each were included in this study. Group A patients were induced and maintained with propofol. Group B patients were induced with thiopentone and maintained with isoflurane. All patients were administered 30mug.kg(-1) butorphanol intravenously 10 minutes before induction of anaesthesia, followed by slow injection of 30mug.kg(-1) midazolam. All were assessed for sedation, respiratory insufficiency, postoperative nausea and vomiting (PONV) and other side effects in the recovery room. We found no difference in demographic parameters between the groups. The fall in HR was maintained in the post induction / intubation period and throughout the intraoperative period in Group A, unlike Group B patients in whom it r...
Background: A variety of minimally invasive techniques (chemonucleolysis, laser, automated percut... more Background: A variety of minimally invasive techniques (chemonucleolysis, laser, automated percutaneous discectomy, percutaneous manual nucleotomy) have been invented over the years, as treatment of low back pain related to disc disease. Automated percutaneous lumbar dissectomy (APLD), being one of these techniques, is a modality in which removal of nucleus pulposus, reduces intradiscal pressure thus relieves the nerve root compression and subsequently reduces radicular pain. This technique was introduced by Onik in 1985, referred to as ‘automated’ since it involves a mechanical probe, working by a ‘suction and cutting action for removal of the nucleus pulposus. Methodology: After meeting the inclusion criteria, minimal invasive procedure – APLD, performed in between 2012 to 2015 on 120 patients on outdoor basis. Radicular discogenic pain was confirmed by MRI and clinical finding, procedure is being performed using nucleotome under fluoroscopic guidance. Result: Based on patient sat...
Severe cardiovascular responses in the form of tachycardia and hypertension following nasal specu... more Severe cardiovascular responses in the form of tachycardia and hypertension following nasal speculum insertion occur during sublabial rhinoseptal trans-sphenoid approach for resection of small pituitary tumours. We compare the effects of preoperative administration of clonidine (α-2 agonist) and atenolol (α-blocker) over haemodynamic response, caused by speculum insertion during trans-sphenoid pituitary resection. We enrolled 66 patients in age range 18-65 years, of ASA I-II, and of either sex undergoing elective sublabial rhinoseptal trans-sphenoidal hypophysectomy. Group I (control) received placebo, group II (clonidine) received tablet clonidine 5 µg/kg, and group III (atenolol) received tablet atenolol 0.5 mg/kg. The heart rate increased on speculum insertion and 5 and 10 minutes following speculum insertion as compared to the pre-speculum values in the control group, while no change in the heart rate was observed in other groups (P<0.05). There was a rise in the mean arterial pressure during and 5, 10, and 15 minutes after nasal speculum insertion in the control group, whereas it was not seen in other groups (P<0.05). We therefore suggest that oral clonidine and oral atenolol (given 2 hours prior to surgery) is an equally effective and safe method of attenuating haemodynamic response caused by nasal speculum insertion during trans-sphenoid pituitary resection.
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