Babita Ghai
PGIMER,CHD,India, Anaesthesia and Intensive Care, Faculty Member
Research Interests: Multilingualism, Chronic Pain, Quality of life, Medicine, Physical Therapy, and 15 moreHindi, Low back pain, India, Humans, Female, Confirmatory factor analysis, Construct Validity, Male, Pain Medicine, Middle Aged, Adult, Pilot Projects, Pain Measurement, Catastrophization, and Pharmacology and pharmaceutical sciences
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Research Interests: Chronic Pain and Medicine
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mg/dL. Computed tomography angiography of the head and neck did not show any evidence of infarction, bleeding, or vessel stenosis. Magnetic resonance imaging of the brain did not show any leptomeningeal disease or metastatic disease.... more
mg/dL. Computed tomography angiography of the head and neck did not show any evidence of infarction, bleeding, or vessel stenosis. Magnetic resonance imaging of the brain did not show any leptomeningeal disease or metastatic disease. Cerebrospinal fluid studies revealed normal opening pressure and absence of malignant cell. Biopsy of bilateral temporal arteries did not show any inflammation. He was started on methylprednisolone at 1 g/kg with high suspicion for high-grade irAE of the optic nerve. This was later switched to oral prednisone with tapering dose on discharge. The patient’s vision loss did not recover at all even after few months of follow-up. Further treatment with nivolumab plus ipilimumab was discontinued given the grade 4 toxicity. Repeat staging scans, however, showed partial response to the treatment. His therapy was then switched to oral cabozantinib 60 mg daily. Nivolumab and ipilimumab are fully human immunoglobulin G4 (PD-1) and a human CTLA-4 (immune checkpoint inhibitor antibody), respectively. Antibodies against CTLA-4 and PD-1 cause adverse events through activation of host’s immune system and decrease in self-tolerance, which results in T-lymphocyte–mediated autoimmune response. The rate of systemic irAE with ipilimumab and nivolumab is as high as 96%, while the incidence of ophthalmic irAE is ,1%.4 The most common neurological manifestations occur within 2–12 weeks of initiating immune checkpoint inhibitors, and the range of ocular manifestations can vary from benign to sight-threatening.5 After the second cycle, our patient experienced diplopia due to right trochlear nerve palsy. His vision loss in the left eye was likely due to PION. PION is a diagnosis of exclusion which causes acute vision loss with ipsilateral relative afferent pupillary defect and normal appearing optic disc. Nivolumab plus ipilimumab therapy causing either trochlear nerve palsy or PION has not been reported previously, and to the best of our knowledge, this is the first case report describing this adverse event. Naranjo Score for both these adverse events is 6, indicating probable adverse drug reaction. Oncologists should keep aware of this adverse event as early detection and initiation of high-dose steroids can possibly prevent further deterioration of vision.
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Research Interests: Chronic Pain and Medicine
Background and aims Dexamethasone is a widely used adjuvant to local anesthetics for acute pain management. Though previous studies have compared the analgesic efficacy of i/v and perineural Dexamethasone, however none have evaluated... more
Background and aims Dexamethasone is a widely used adjuvant to local anesthetics for acute pain management. Though previous studies have compared the analgesic efficacy of i/v and perineural Dexamethasone, however none have evaluated systemic absorption of perineurally administered Dexamethasone. With the idea of finding some clarification of mechanism of action of Dexamethasone, we compared systemic levels of perineurally administered Dexamethasone with that given intravenously. Our primary outcome was to evaluate the blood levels of dexamethasone after its administration either perineurally or intravenously. Methods After ethics committee approval, we included 30 patients undergoing unilateral upper limb surgery under ultrasound-guided supraclavicular brachial plexus block. Subjects were randomized to receive ultrasound-guided supraclavicular brachial plexus block using 0.375% Bupivacaine (25ml) with Dexamethasone (8mg) given either perineurally (group I) or intravenously (group II). Blood Dexamethasone levels were measured before drug administration, at 20, 40, 60 min, 2, 4, 8 and 12 hours after Dexamethasone administration. Postoperatively, patients were monitored for pain for 24 hours. Patients with NRS≥4 received i/v tramadol 2mg/kg. Results The groups had comparable average maximum serum concentrations (Cmax) of Dexamethasone (Average Cmax=11403.61±4876.52ng/ml in group I and 12418.59±2414.92ng/ml in group II; p value=0.48), with average time until achieving Cmax of Dexamethasone being 20minutes. Area under the concentration curve (AUC(0-t)) was comparable between the two groups (59632.34±30769.74nghr/ml in group I and 61718.41±19479.34nghr/ml in group II; p value=0.83). Conclusions Most of perineurally administered Dexamethasone was absorbed systemically. Thus, the possible mechanism of action of perineurally administered Dexamethasone could be similar to that administered intravenously, with most of its effect being due to its systemic absorption.
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Summary The optimal end-tidal sevoflurane concentration for successful ProSeal™ (Teleflex, Morrisville, NC, USA) laryngeal mask airway (PLMA) versus Classic™ (Teleflex, Morrisville, NC, USA) laryngeal mask airway (CLMA) insertion in... more
Summary The optimal end-tidal sevoflurane concentration for successful ProSeal™ (Teleflex, Morrisville, NC, USA) laryngeal mask airway (PLMA) versus Classic™ (Teleflex, Morrisville, NC, USA) laryngeal mask airway (CLMA) insertion in unpremedicated anaesthetised adults is unknown. We determined end-tidal sevoflurane concentrations for successful insertion in fifty percent of anaesthetised adults. This randomised, prospective, double-blind study was conducted in the operating theatre of a government tertiary care hospital. Forty-four unpremedicated American Society of Anesthesiologists physical status I and II women with cervical carcinoma (aged 30 to 60 years), scheduled for intracavity caesium implantation under general anaesthesia with a laryngeal mask airway (LMA) were included in the study. The participants were randomised to one of the two groups, to receive either a PLMA or CLMA. After anaesthetic induction with sevoflurane, a predetermined end-tidal sevoflurane concentration (...
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Introduction: Lockdown during the initial wave of the COVID-19 pandemic and isolation were discovered to have a negative psychological influence on the general population’s mental health and wellbeing. Aim: This study aims to Trace and... more
Introduction: Lockdown during the initial wave of the COVID-19 pandemic and isolation were discovered to have a negative psychological influence on the general population’s mental health and wellbeing. Aim: This study aims to Trace and compares the impact of the COVID-19 pandemic on mental health in terms of psychological well-being (PWB), distress and family functioning during the first and second wave. Materials and Methods: A convenient purposive sampling method was used to conduct an online survey during the first COVID wave (May 2020–July 2020) in India, and the same demographic group was re-contacted (March 2021–May 2021) during the second wave. The institute ethical committee was consulted in advance for approval, and participants’ digital consent was obtained. The first and second waves of the COVID-19 epidemic in India were evaluated using the PWB scale, the depression anxiety stress scale 21, and the brief family relationship scale. Results: Among all individuals, there wa...
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Studies that have compared and quantified the oropharynageal leak pressure (OPLP) and adequacy of ventilation with supraglottic airway devices in different head and neck positions have been done in adult populations. The effects of... more
Studies that have compared and quantified the oropharynageal leak pressure (OPLP) and adequacy of ventilation with supraglottic airway devices in different head and neck positions have been done in adult populations. The effects of head-neck position changes on the functioning of I-gel(™) in pediatric population still remain unevaluated. This study aimed to quantify the influence of different head and neck positions namely neutral, maximum flexion, and maximum extension on OPLP, ventilation scoring, and fiberoptic grading using I-gel(™) in anesthetized, paralyzed children. I-gel(™) was inserted in 30 paralyzed, anesthetized children scheduled for elective urological and orthopedic procedures. Anesthesia was induced with sevoflurane in oxygen. Atracurium was administered intravenously to facilitate neuromuscular relaxation. Recordings of OPLP in neutral, maximum flexion, and maximum extension were taken as primary outcome. Fiberoptic grading, insertion of ryle's tube and ventilation scoring were also measured in different head and neck positions as secondary outcomes. The OPLP was significantly higher in flexion (27.6 ± 3.3 cm H2 O, P = 0.000) and lower in extension (19.6 ± 3.2 cm H2 O, P = 0.006) in comparison to the neutral position (23.2 ± 3.2 cm H2 O). There was a worsening of the fiberoptic view in flexion compared to neutral position (0/5/19/6 vs 5/21/4/0). The ventilation score was poorer (1 [0-3], P < 0.05) and peak inspiratory pressures higher in flexion (15.2 ± 1.4 cm H2 O, P = 0.000) compared to the neutral position (10.4 ± 1.6 cm H2 O). Caution is warranted in pediatric patients while ventilating with I-gel(™) in extreme flexion of head and neck owing to poor ventilation despite increase in OPLP.
Research Interests: Medicine, Humans, Child, Paediatric Anaesthesia, Female, and 15 moreMale, Anesthesia, PARALYSIS, Infant, Head, Pediatric Anaesthesia, Airway, Neck, Pediatric Anesthesia, Fiber Optic Technology, Orthopedic Procedures, Patient Positioning, Child preschool, Paediatrics and reproductive medicine, and Respiration Artificial
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Oral premedication with midazolam and ketamine is widely used in pediatric anesthesia to reduce emotional trauma and ensure smooth induction. However, various dosing regimens when used alone or in combination have variable efficacy and... more
Oral premedication with midazolam and ketamine is widely used in pediatric anesthesia to reduce emotional trauma and ensure smooth induction. However, various dosing regimens when used alone or in combination have variable efficacy and side effect profile. The aim of our study was to investigate and compare the efficacy of oral midazolam alone with a low-dose combination of oral midazolam and ketamine. We performed a prospective randomized double-blind study in 100 children who were randomly allocated into two groups. Group M received 0.5 mg.kg(-1) oral midazolam and group MK received 0.25 mg.kg(-1) oral midazolam with 2.5 mg.kg(-1) oral ketamine. The preoperative sedation score, ease of parental separation and ease of mask acceptance were evaluated on a 4-point scale. The time to recovery from anesthesia and to achieve satisfactory Aldrete score was also noted. Uniform and acceptable sedation scores were seen in both the groups (group M 95.9%; group MK 97.96%), without any serious side effects. However, the combination offered significantly more children in an awake, calm and quiet state, who were easily separated from their parents (73.46% in MK vs 41% in group M). The induction scores were comparable between the groups. The recovery room characteristics and time to achieve satisfactory Aldrete score were also comparable between the two groups. Oral midazolam alone and a combination of midazolam with ketamine provide equally effective anxiolysis and separation characteristics. However, the combination provided more children in an awake, calm and quiet state who could be separated easily from parents.
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Heparins and coumarins have been ruling the anticoagulant class for the past 60 years, but the trend in the drug discovery, prominence of target-based approach, and high-throughput screening has brought newer molecules in the forefront.... more
Heparins and coumarins have been ruling the anticoagulant class for the past 60 years, but the trend in the drug discovery, prominence of target-based approach, and high-throughput screening has brought newer molecules in the forefront. Newer oral anticoagulants (NOACs) with different therapeutic challenges have largely come up in the past 5 years and overcome the limitations of traditional anticoagulants. The debate for specific guidelines for their use has been on for years. Interventional pain physicians admonished that available guidelines for regional anesthesia in patients receiving anticoagulants were insufficient as pain procedures covered a far broader gamut reflecting diverse goals. Hence, experts from different groups and committees got together and summed up guidelines and stratified interventional pain procedures based separately on patient- and procedure-specific factors. Here, in this review, we discuss the NOACs and their impact on interventional pain procedures.
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Background: Intralesional injection of triamcinolone acetonide (TAC) is the most frequently used treatment modality for keloids or hypertrophic scars. However, 20 mg/mL, triamcinolone is reported to have 50% incidence of adverse sequelae.... more
Background: Intralesional injection of triamcinolone acetonide (TAC) is the most frequently used treatment modality for keloids or hypertrophic scars. However, 20 mg/mL, triamcinolone is reported to have 50% incidence of adverse sequelae. We compared the long-term safety and efficacy of 10 mg/mL with 20 mg/mL intralesional injection of TAC on sternal keloid pain. Methods: Thirty adult patients presenting with pain and/or pruritis at sternal keloid site were randomized into one of the two groups. In group T20 patient received 1 mL of 20 mg/mL TAC, whereas in group T10 patients received 1 mL of 10 mg/mL of TAC intralesional every 2 weeks for a total of 3-4 treatments. Visual analog scale (VAS) scores for pain and pruritis, keloid/scar height, and any adverse sequelae were recorded at 2 weeks interval till 2 months and then at 6, 12, and 15 months. Primary outcome of the study was the percentage of patient developing side effects. Secondary outcome measures were VAS score for pain and itching, keloid height, and recurrence rate of pain or itching. Results: There was a significant decrease in VAS score for pain, pruritis, and keloid height after drug administration in both groups. Side effects was observed in 6 (40%) patients in group T20 and 1 (6.7%) patients in group T10 ( P = 0.04). Two patients (13.3%) in group T20 and one in group T10 (6.7%) did not have any improvement in their pain/pruritis scores. Recurrence rate was 13.3% (2 patients) in T20 group compared with 20% (3 patients) in group T10 at 15 months after initial response. Conclusion: Intralesional injection of TAC in concentration of 10 mg/mL is as efficacious as 20 mg/mL for sternal keloid pain but is associated with significantly less side effects.
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Aims: Spinal hypotension using conventional local anesthetic doses for elective cesarean delivery (CD) has been associated with fetal acidosis. The optimum anesthetic technique for laboring women with nonreassuring fetal heart trace (FHR)... more
Aims: Spinal hypotension using conventional local anesthetic doses for elective cesarean delivery (CD) has been associated with fetal acidosis. The optimum anesthetic technique for laboring women with nonreassuring fetal heart trace (FHR) and its effects on neonatal outcome has not been well studied. Materials and Methods: Thirty laboring parturients with a nonreassuring FHR undergoing emergency CD (category 2) were included in this study. The parturients were randomized to receive a low-dose spinal anesthesia (LDSA group) 8 mg hyperbaric 0.5% bupivacaine with 20 μg fentanyl, or standard general anesthesia (GA group). Systolic blood pressure was maintained at >100 mmHg till delivery of the fetus using phenylepherine boluses. The primary outcome variable was cord blood gas base excess >8 meq/L. Statistical Analysis: Assuming an SD of 7.5 and difference of 5 as clinically significant difference in base deficit, we required 15 patients in each group with α of 0.05 and power of 90%. Student's t test, two-way repeated measures analysis of variance (ANOVA) and Chi square test were used to analyze the data. Results: The incidence of fetal acidosis was higher in the GA group. Lower APGAR scores at 1 and 5 min and a greater need for immediate resuscitation was observed in fetuses exposed to GA. All patients in the LDSA group achieved adequate surgical block as well as stable hemodynamics. No adverse event was observed with either of the techniques. Conclusion: A LDSA is associated with better neonatal outcome in women with nonreassuring FHR as compared with GA.
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1 Murphy KC, Jones RG, Griffiths E et al. Chromosome 22q11 deletions. An unrecognized cause of idiopathic learning disability. Br J Psychiatry 1998; 172: 180–183. 2 Driscoll DA, Emanuel BS. Di George and velocardiofacial syndromes: the... more
1 Murphy KC, Jones RG, Griffiths E et al. Chromosome 22q11 deletions. An unrecognized cause of idiopathic learning disability. Br J Psychiatry 1998; 172: 180–183. 2 Driscoll DA, Emanuel BS. Di George and velocardiofacial syndromes: the 22q11 deletion syndrome. MRDD Res Rev 1996; 2: 130–138. 3 Dunham I, Shimizu N, Roe BA et al. The DNA sequence of human chromosome 22. Nature 1999; 402: 489–495. 4 Jastak JT, Yagiela JA. Vasoconstrictors and local anesthesia: a review and rationale for usage. J Am Dent Assoc 1983; 107: 623– 630. 5 Meechan JC, Cole B, Welbury RR. The influence of two different dental local anaesthetic solutions on the haemodynamic responses of children undergoing restorative dentistry: a randomised, single-blind, split-mouth study. Br Dent J 2001; 190: 502–504. 6 Cotton BR, Henderson HP, Achola KJ et al. Changes in plasma catecholamine concentrations following infiltration with large volumes of local anaestthetic solution containing adrenaline. Br J Anaesth 1986; 58: 593–597. 7 Jage J. Circulatory effects of vasoconstrictors combined with local anesthetics. Anesth Pain Control Dent 1993; 2: 81–86. 8 Lipp M, Dick W, Daublander M et al. Exogenous and endogenous plasma levels of epinephrine during dental treatment under local anesthesia. Reg Anesth 1993; 18: 6–12. 9 Replogle K, Reader A, Nist R et al. Cardiovascular effects of intraosseous injection of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine. J Am Dent Assoc 1999; 130: 649–657. 10 Chernow B, Balestrieri F, Ferguson CD et al. Local dental anesthesia with epinephrine. Minimal effects on the sympathetic nervous system or on hemodynamic variables. Arch Intern Med 1983; 143: 2141–2143. 11 Palmatier MA, Kang AM, Kidd KK. Global variation in the frequencies of functionally different catechol-O-methyltransferase alleles. Biol Psychiatry 1999; 46: 557–567. 12 Lachman HM, Morrow B, Shprintzen R et al. Association of codon 108/158 catechol-O-methyltransferase gene polymorphism with the psychiatric manifestations of velo-cardiofacial syndrome. Am J Med Genet 1996; 67: 468–472.
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End-tidal concentration of sevoflurane for I-gel insertion in children has not been studied. This study was designed to determine the sevoflurane EC50 and EC95 for I-gel placement in children as compared with classic laryngeal mask airway... more
End-tidal concentration of sevoflurane for I-gel insertion in children has not been studied. This study was designed to determine the sevoflurane EC50 and EC95 for I-gel placement in children as compared with classic laryngeal mask airway (CLMA) placement. The design was a prospective, randomized controlled study. The setting was single tertiary care center. Pediatric subjects of either sex aged 1.5-8 years, weighing 10-20 kg having American Society of Anesthesiologists physical status I/II of undergoing elective cataract surgery were included in the study. Induction and maintenance of anesthesia were achieved with sevoflurane and oxygen with preservation of spontaneous breathing. Children were randomly subjected to either I-gel size 2 (group I) or CLMA size 2 (group II) insertion. The target end-tidal sevoflurane concentration (ET SEVO) was maintained for 8-10 minutes before supraglottic airway device was inserted in both the groups. In the first child, the ET SEVO was kept at 2% and was increased or decreased by 0.2% in the next child depending on the previous child's response according to Dixon method. After each supraglottic airway device insertion, child was observed for 1 minute for any "movement" or "no movement." The measurements were EC50 and EC95 for I-gel and CLMA placement in children. EC50 and EC95 for group I were 0.94% (0.83%-1.06%) and 1.26% (1.12%-1.66%) and for group II were 1.9% (1.70%-2.1%) and 2.54% (2.24%-3.41%), respectively. I-gel insertion in children can be accomplished at nearly half ET SEVO (0.94%) of that required for CLMA insertion (1.9%).
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ObjectivesHealthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19... more
ObjectivesHealthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty.SettingOur tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless.ParticipantsWe recruited willing low-risk HCP, aged <50 years, ...
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This is a controlled randomized trial which evaluated the clinical and molecular changes resulting from Integrated approach of yoga therapy (IAYT) as an adjunct regimen and compared it with usual care for the management of chronic low... more
This is a controlled randomized trial which evaluated the clinical and molecular changes resulting from Integrated approach of yoga therapy (IAYT) as an adjunct regimen and compared it with usual care for the management of chronic low back pain patients. We enrolled 29 adult patients with chronic low back pain (CLBP). Patients were randomly divided into two groups. Control group received the usual care of treatment as per institutional protocol. The yoga group received IAYT as an adjunct to usual care. Primary outcomes were pain Intensity assessed by verbal numerical rating scale (VNRS) and functional ability assessed by Modified Oswestry Disability Index (MODI). Secondary outcomes were pain catastrophizing, quality of life, fear of movement related to CLBP, type of pain, levels of ß-Endorphin and TNF α and Salivary CGRP. All parameters were measured at baseline, one month, and three months. Significant decrease in VNRS score at 1 and 3 months was observed in both the groups with ...
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The COVID pandemic has affected pain practice throughout the world. It has now become amply clear that the pandemic is here to stay for long. Pain physicians have a very important role to play in the pandemic and that is taking care of... more
The COVID pandemic has affected pain practice throughout the world. It has now become amply clear that the pandemic is here to stay for long. Pain physicians have a very important role to play in the pandemic and that is taking care of the chronic pain patients to avoid complications. This responsibility falls in the essential service category and cannot be shrugged off the shoulders by practitioners of pain medicine. Initially, various associations, societies, and organizations came up with various guidelines recommending management options following a conservative approach. However, the stance has changed almost on a real-time basis, and the current approach is to decide management on a case-to-case basis. This unique scenario has put up a lot of challenges ahead for the budding superspecialty of pain medicine. However, it also offers some opportunities which can pave the way for a bright future for the pain physicians and more importantly for their patients.
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Opioids are an indispensable part of perioperative pain management of cancer surgeries. Opioids do have some side effects and abuse potential, and some laboratory data suggest a possible association of cancer recurrence with perioperative... more
Opioids are an indispensable part of perioperative pain management of cancer surgeries. Opioids do have some side effects and abuse potential, and some laboratory data suggest a possible association of cancer recurrence with perioperative opioid use. Opioid-free anesthesia and opioid-sparing anesthesia are emerging new concepts worldwide to safeguard patients from adverse effects of opioids and potential abuse. Opioid-free anesthesia could lead to ineffective pain management, leaving the perioperative physician with limited options, while opioid-sparing anesthesia may be a rational approach. This consensus guideline includes general considerations of the safe use of perioperative opioids along with concomitant use of central neuraxial or regional blockade and systematic nonopioid analgesics. Region-specific onco-surgeries with their specific recommendations and consensus statements for judicious use of opioids are suggested. Use of epidural analgesia or regional catheter during thor...
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Background: Hindi translation and cross language concordance and validation of child version of Loneliness and Dissatisfaction Questionnaire (LSDQ-C), Parent Child Relationship (PCRQC) and Conflict Behavior Questionnaire (CBQ-C) would... more
Background: Hindi translation and cross language concordance and validation of child version of Loneliness and Dissatisfaction Questionnaire (LSDQ-C), Parent Child Relationship (PCRQC) and Conflict Behavior Questionnaire (CBQ-C) would expedite generating data from India. Objective: To translate the parallel forms (parent and child versions) of English version of the LSDQ-C, PCRQ-C and CBQ-C and into Hindi and evaluate its psychometric properties. Methods: Hindi translation and cross language adaptation of LSDQ-C, PCRQ-C and CBQ-C was done following WHO guidelines. Children aged 10- 18 years of age, studying in either government or private schools of Chandigarh, whose parents given assent for their children were enrolled through snowball convenient random sampling technique. Psychometric properties were 2 assessed by using intraclass correlation (ICC), chronbach’s alpha, test retest reliability, paired t test, and split half reliability. Results: Item wise test retest reliability of ...
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Background: Transforaminal (TF) lumbar injection is a commonly used minimally invasive intervention for management of chronic low back pain. TF injection can be performed using various approaches to inject the drug to the anterior... more
Background: Transforaminal (TF) lumbar injection is a commonly used minimally invasive intervention for management of chronic low back pain. TF injection can be performed using various approaches to inject the drug to the anterior epidural space (AES). Objectives: To identify the volumes of contrast medium needed to reach the AES and other landmarks in the Kambin triangle (KB) and subpedicular (SP) approach of TF injection in patients with lumbosacral radicular pain. Study Design: Randomized controlled trial. Setting: Pain clinic and operating room of a tertiary care hospital. Methods: Seventy-five eligible patients were randomized to receive TF epidural injection either by SP (SP group; n = 38) or the KB (KB group; n = 37) approach under fluoroscopic guidance. After confirming the appropriate needle position, contrast medium was injected at 0.5 mL increments up to 2 mL under intermittent fluoroscopy. Contrast medium volumes needed to reach specific landmarks, that is, AES, medial t...
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Supplemental Digital Content is available in the text. Precis: This study evaluated 2 doses of intranasal dexmedetomidine (IND) (3.0 and 3.5 µg/kg) as a procedural sedative for postoperative examination of children with glaucoma. A dose... more
Supplemental Digital Content is available in the text. Precis: This study evaluated 2 doses of intranasal dexmedetomidine (IND) (3.0 and 3.5 µg/kg) as a procedural sedative for postoperative examination of children with glaucoma. A dose of 3.5 µg/kg was more efficacious and obviated the need for repeated general anesthesia. Purpose: This study was carried out to determine the safety and effective dose of IND as a procedural sedative for postoperative follow-up examinations after glaucoma surgery in children in place of repeated examination under anesthesia. Materials and Methods: In this prospective randomized double-blinded interventional study, consecutive children aged 6 months to 6 years were randomized to receive 3.0 and 3.5 µg/kg IND using a mucosal atomizer device in the preoperative area of the operating room, under continuous monitoring of vital signs. Intranasal midazolam 0.25 mg/kg was used as a rescue agent in case of inadequate sedation, and general anesthesia was administered in case of persistent failure. All infants underwent a complete anterior and posterior segment evaluation including intraocular pressure and corneal diameter measurements. Results: A total of 30 and 31 children aged 23.9±15.0 and 19.2±10.1 months, respectively, received 3.0 and 3.5 µg/kg IND. Adequate sedation was possible in 18 of 30 (60%) children receiving 3.0 µg/kg and 24 of 31 (77.4%) receiving 3.5 µg/kg IND alone (P=0.17). In combination with midazolam, successful sedations were 86.6% versus 100%, respectively (P=0.052). One patient in the 3.5 µg/kg group had ventricular arrhythmia, reversed with dextrose-saline infusion and injection glycopyrrolate. Conclusions: IND appears to be a safe and effective procedural sedative for postoperative follow-up examinations of pediatric glaucoma patients at doses of 3 and 3.5 µg/kg. The dose of 3.5 µg/kg was successful in more children.
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Background: Vitamin D has a significant role to play in bone metabolism and neuromuscular function. Several researchers have indicated that Vitamin D deficiency may be possibly related to chronic musculoskeletal pain including chronic low... more
Background: Vitamin D has a significant role to play in bone metabolism and neuromuscular function. Several researchers have indicated that Vitamin D deficiency may be possibly related to chronic musculoskeletal pain including chronic low back pain (CLBP). Objectives: The present study was conducted to determine the prevalence of hypovitaminosis D and its contribution to chronic lower back pain. Study Design: Controlled study Setting: Outpatient pain clinic of tertiary care hospital. Methods: Data presented in this manuscript are from patients who were screened for inclusion in an open label, single arm clinical trial aimed to assess the effectiveness of vitamin D supplementation in patients with CLBP. Consecutive patients visiting the outpatient pain clinic of a tertiary care hospital with a diagnosis of CLBP with or without leg pain were recruited. A visual analogue scale (VAS) was used to measure low back pain intensity, and the Modified Oswestry disability questionnaire (MODQ) w...
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Heparins and coumarins have been ruling the anticoagulant class for the past 60 years, but the trend in the drug discovery, prominence of target-based approach, and high-throughput screening has brought newer molecules in the forefront.... more
Heparins and coumarins have been ruling the anticoagulant class for the past 60 years, but the trend in the drug discovery, prominence of target-based approach, and high-throughput screening has brought newer molecules in the forefront. Newer oral anticoagulants (NOACs) with different therapeutic challenges have largely come up in the past 5 years and overcome the limitations of traditional anticoagulants. The debate for specific guidelines for their use has been on for years. Interventional pain physicians admonished that available guidelines for regional anesthesia in patients receiving anticoagulants were insufficient as pain procedures covered a far broader gamut reflecting diverse goals. Hence, experts from different groups and committees got together and summed up guidelines and stratified interventional pain procedures based separately on patient- and procedure-specific factors. Here, in this review, we discuss the NOACs and their impact on interventional pain procedures.
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Research Interests: Treatment Outcome, Medicine, Low back pain, Humans, Female, and 15 moreFluoroscopy, Male, Anesthesia, Clinical Sciences, Visual Analogue Scale, Middle Aged, Adult, Neurosciences, Intraoperative Neurophysiological Monitoring, lumbar vertebrae, Methylprednisolone, lumbar, Interventional pain management, Oswestry Disability Index, and Radicular pain
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Background: Low back pain (LBP) is ranked highest in terms of disability-adjusted life-years lived. Patient education and self-management have shown to play a crucial role in the overall pain management. However, the literature on the... more
Background: Low back pain (LBP) is ranked highest in terms of disability-adjusted life-years lived. Patient education and self-management have shown to play a crucial role in the overall pain management. However, the literature on the same with respect to Indian context is still lacking. The study was aimed to develop, validate and assess the acceptability and effectiveness of self-instructional educational module among Indian chronic LBP (CLBP) patients. Methods: A prospective single-arm open-label study was conducted in a pain clinic of a tertiary care public hospital in North India with 'Backcare booklet-self-instructional module (SIM)' as an intervention in patients with CLBP. SIM was developed with the intent to provide up-to-date evidence-based information in an easy understanding way to patients with CLBP. 132 patients were administered SIM with a single session of verbal explanation. Pain intensity (numeric rating scale [NRS]), disability, fear-avoidance belief Questionnaire (FABQ), quality of life (EQ5D) and knowledge level were assessed at baseline and after 3 months of intervention. Student's paired t-test and Chi-square test were used. Data were analysed using SPSS version 15.0. Results: 120 patients successfully completed the 3 months' follow-up. Significant reductions were observed in pain intensity (76[12] vs 55 [15, P < 0.01); disability (51[14] vs 43 [10], P < 0.01); FABQ (46[12] vs 41 [10], P < 0.01); EQ5D (0.35 [0.27] vs 0.18 [0.26], P < 0.01). Conclusion: Backcare booklet as an intervention, along with usual pharmacological care is a cost-effective educational medium to promote self-management of CLBP in the clinical outpatient settings.
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The COVID pandemic due to the severe acute respiratory syndrome-coronavirus-2, also known as SARS-CoV-2 (COVID-19), has affected humans across the globe. This document on pain practice reflects the current position statement of the Indian... more
The COVID pandemic due to the severe acute respiratory syndrome-coronavirus-2, also known as SARS-CoV-2 (COVID-19), has affected humans across the globe. This document on pain practice reflects the current position statement of the Indian Society for Study of Pain.
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Treatment of chronic pain is an essential service. Due to lockdown, travel restrictions, social and physical distancing requirements or fear that health care facilities may be infected; patients may avoid visiting health care facilities... more
Treatment of chronic pain is an essential service. Due to lockdown, travel restrictions, social and physical distancing requirements or fear that health care facilities may be infected; patients may avoid visiting health care facilities in person. It is also imperative to decrease the risk of exposure of the health care workers (HCWs) to severe acute respiratory syndrome corona virus 2 (SARS CoV2) and to ease the overtly burdened health care system. But any disruption in pain practice will have alarming consequences for individuals, society, and whole of health care system and providers. In the current scenario of COVID-19 pandemic, telemedicine is emerging as a key technology for efficient communication and sustainable solution to provide essential health care services and should be considered for chronic pain patients (CPPs). Recently, Board of Governors in supersession of Medical Council of India along with National Institution for Transforming India (NITI Aayog) released “Telemedicine Practice Guidelines” enabling registered medical practitioners to provide healthcare using telemedicine. This article describes the challenges in CPPs during COVID-19 pandemic and the use of telemedicine as the rescue management vehicle for CPPs in current scenario.
Research Interests:
Background: Emerging evidence suggests an association between vitamin D deficiency and low back pain (LBP). Objective: To pool evidence on the prevalence of hypovitaminosis D in patients with LBP. Study Design: Meta-analysis. Methods: A... more
Background: Emerging evidence suggests an association between vitamin D deficiency and low back pain (LBP). Objective: To pool evidence on the prevalence of hypovitaminosis D in patients with LBP. Study Design: Meta-analysis. Methods: A comprehensive literature search was done in PubMed, Cochrane Database, and Google scholar for observational studies including cohort, cross sectional (CS), and case control (CC) evaluating the prevalence of hypovitaminosis D in LBP patients. The primary outcome assessed was a prevalence of hypovitaminosis D in patients with LBP, presented as weighted pooled prevalence ratio (WPPR) with 95% confidence interval (CI) using the random effects model. Heterogeneity and inconsistency of the measurements were identified through Cochran’s Q statistic and I2 statistic. We also performed sensitivity analysis, publication bias (using funnel plot and Begg’s test), and subgroup analysis. Results: Fourteen studies (6 were CC, 6 CS, and 2 cohort) involving 2602 pati...