ABSTRACT
Introduction: Temporo-mandibular joint (TMJ) arthritis isone of the distressing features of many polyarthritic disordersbecause of interference with mastication. Usually bilateraljoint affection may be a part a larger profile of multiplejoint involvements. Yet, it can present as an isolated entity.Establishing analgesia and improving mouth opening are thekey features in the management of the case.Case report: A 23 year old male with no co-morbiditiespresented with restricted and painful mouth opening anddifficulty in mastication for the past two months. He wasdiagnosed as bilateral temporo-mandibular joint arthritis andreferred to us for pain control. Routine investigations werenormal. Ultrasound guided intra-articular temporo-mandibularjoint injection was administered with a combination ofbupivacaine and methylprednisolone bilaterally. There wasa significant improvement in mouth opening and pain scoreVAS < 3 and on a three month follow up, there was no sideeffects and no requirement for further analgesics.Conclusion: We present such a unique case since there is verylittle literature on effectiveness of ultrasound guided intraarticular steroid injection on a case of isolated TMJ arthritisin Indian population.
ABSTRACT
Background: Single dose subarachnoid anesthesia is a commonly used anesthetic technique for pelvic and lower limb surgeries. Various adjuvants, e.g. opioids, alpha 2 agonists, neostigmine, midazolam etc. have been used to counter some of the shortcomings of the technique. Synthetic lipid soluble opioids like fentanyl for hemodynamic stability or clonidine for prolongation of duration have been used. We wanted to compare both the drugs with a control when used in conjunction with local anesthetics in lower abdominal and pelvic surgeries with regard to sensory and motor block with early postoperative analgesia along with their side effect profile
Methodology: One hundred and fifty adult patients of ASA status I and II, posted for lower abdominal and pelvic surgeries, were randomly divided into three groups. Group BC [bupivacaine + clonidine] received 50 micro g clonidine while BF [bupivacaine + fentanyl] received 50 micro g of fentanyl, the third group received equal volumes of normal saline [Group NS, bupivacaine + normal saline] for subarachnoid block. The duration of anesthesia, analgesia, motor blockade and side effects like sedation, bradycardia and hypotension were noted and subjected to statistical analyses with ANOVA [analysis of variance] and Kruskal-Wallis test as and when appropriate
Results: All of the 150 patients completed the study. The duration of surgical anesthesia was not significantly higher in the experimental groups. But the duration of analgesia was higher in BC than BF which in turn was higher than the Group NS [281.26 +/- 97.57, 237.80 +/- 58.49 min and 190.48 +/- 61.94 min respectively]. The sedation and the intraoperative motor blockade were similar, in Group BC, L1 regression time was 232.76 +/- 94 min which was higher compared to Group BF [202.34 +/- 60 min] and Group BN [172.28 +/- 56 min] but statistically insignificant. The hemodynamic instability with regard to hypotension was more in Group BC than BF
Conclusion: Addition of 50 micro g of clonidine to intrathecal bupivacaine produces prolonged duration of analgesia in surgical anesthesia. The onset of hemodynamic imbalance was from forty minutes in Group BC which prompts for an additional monitoring in those cases. There is no excess sedation with the above said dose of clonidine