ABSTRACT
Introduction: Chronic unrelieved pain is not only a major drain on scarce health care resources, but it is the cause of needless suffering of millions of people worldwide. The direct palpable costs to these patients and their families include loss of job, loss of income, loss of savings, and loss of self-esteem. Clearly, the consequences of intractable pain in respect to both its impact our society is staggering. Finding a solution should be a high priority for healthcare intermediaries and health care workers. Abandoning patients when less costly and less invasive intervention does not work to relieve pain is unethical. The neuropathological effect of glycerol was discovered accidentally' and rapidly led to its use as a neurolytic agent in the management of facial pain. Pathology includes numerous inflammatory cells, myelin swelling and axonolysis. As with all neurolytic injuries, lipid droplets can be seen in the cytoplasm of Schwann cells, in phagocytic cells, and in perineal cells, where these droplets accumulate as a nonspecific manifestation of tissue injury. The aim of the study: Aim of the study was to compare the two approaches namely anterior and posterior for neurolysis of coeliac plexus for intractable pain in pancreatic malignancy and chronic pancreatitis. Comparison between the two approaches is ease of technique, accurate placement of needle tip at the coeliac plexus and complications. Materials and methods: Totally 40 patients with diagnosed unresectable pancreatic malignancy and chronic pancreatitis with intractable pain who attended the surgical gastroenterology department of Govt. Stanley Hospital, Chennai during the period of May 2010 to November B Saravanakumaran, S. Sudhakaran. Comparative study on anterior and posterior approaches of coeliac plexus neurolysis on chronic pancreatitis patients in a tertiary care hospital in Chennai. IAIM, 2017; 4(11): 115-121. Page 116 2010 were selected for neurolytic coeliac plexus block with 100% Alcohol. They were grouped randomly into two comprising 20 each 1. Group A: ultrasound guided neurolysis of coeliac plexus through an anterior approach. Group P: fluoroscopy guided neurolysis of coeliac plexus through a posterior approach.on the day of the procedure, the patient was kept fasting for four hours intravenous access secured with 18g venflon approach to celiac plexus was chosen randomly. During the procedure, the patients' vitals were monitored. After the procedure, the patients were kept in ICU for one day for monitoring. The next day, if stable, discharged from the hospital. They were followed by phone about the intensity of pain and any complications like diarrhoea. They were instructed to attend the SGE department at 1, 4 and 8 weeks for assessment of pain relief. Results: 34 patients with pancreatic malignancy and 6 patients of chronic pancreatitis with pain scores of 8 to 10 were taken up for the study. They were allocated randomly into 2 equal groups of 20 each. Group A underwent celiac plexus neurolysis through anterior approach with ultra-sonogram guidance. Group P underwent celiac plexus neurolysis through a posterior approach with fluoroscopic guidance. All the patients received the same amount of neurolytic agent and were followed for 8 weeks. Pain intensity was less after 1 week in group P when compared to group A. At the end of 4th and 8th week, the pain intensity in both the groups was not statically significant of p-value (0.875) assessed by Wilcox son sum test.Patient discomfort score was more in group A when compared to group P which was statically significant of p value<0.001). In our study group P (19) patients were more prone for hypotension when compared to group A (18) which was found to be less significant of p-value <0.005. In our study group P (17) patients had diarrhoea when compared to group A (13) which was found to be less significant of p-value <0.005. In our study group P (19) patients had a backache when compared to group A (2) which was found to be more significant of p-value <0.001. Conclusion: Both the groups reported a similar incidence of pain while injecting alcohol and complications like diarrhoea and hypotension, which was not significant. Patients in group P reported a significant a backache up to 2 weeks which required painkillers. So the study demonstrates both the techniques are similar in successfulness of the block, but the anterior approach is easier to perform with less discomfort to the patients.
ABSTRACT
Background: Pain is regarded as a complex experience consisting of sensory, physiological, psychological and behavioral components. Management of pain can be best achieved by an approach that takes into consideration, the complex interactions between psychological, biological and sociocultural factors. Effective pain management requires thorough preparation of the patient and a structured inpatient service for prevention of postoperative pain. Local anesthetic Ropivacaine is preferred nowadays for epidural postoperative analgesia as it has favorable sensory block profile. The aim of the study: The aim of the study was to compare the postoperative analgesic efficacy of epidural Ropivacaine and Ropivacaine with Tramadol in adults undergoing abdominal surgeries under general anesthesia. Materials and methods: A total of 60 patients were included in the study. Patients were divided into two groups of 30 in each into group R and group RT The study was a prospective non-randomized, double arm, single-blind, controlled study. The sample size was determined based on the study Postoperative analgesic efficacy of epidural Tramadol and adjuvant to Ropivacaine in adult upper abdominal surgeries” Patients who satisfied the above-mentioned inclusion criteria selected were B Saravanakumaran, S.R. Pradeepa. Comparison of postoperative analgesic efficacy of epidural ropivacaine and ropivacaine with tramadol in adults undergoing abdominal surgeries under general anesthesia. IAIM, 2017; 4(11): 76-84. Page 77 counseled about the risks and benefits involved in the study. After getting consent, patients who were willing to be included in the study were enrolled and analyzed. Results: Our study showed the increased mean duration of postoperative analgesia, Ramsay sedation score in Ropivacaine with Tramadol group compared to the Ropivacaine group was statistically significant at the p-value was <0.0001. The association between pruritus status and intervention groups was considered to be nonsignificant since p-value was >0.05 as per Fisher's exact test. The association between heart rate, mean peripheral capillary oxygen saturation, mean respiratory rate in intervention groups was considered to be non-significant since p-value was > 0.05 as per unpaired ttest. Conclusion: From my study, I conclude that the addition of 1 mg/kg of Tramadol improves the postoperative analgesic efficacy of epidural 0.2% Ropivacaine by prolonging the duration of analgesia and providing good sedation with no significant hemodynamic alterations, nausea, vomiting and pruritus