Pain relief in neuropathic pain-a comparison between 0.5% bupivacaine and 0.5% bupivacaine streptomycin combination

Objective: To compare the effectiveness of a combination of streptomycin and bupivacaine for the management of neuropathic pain against bupivacaine alone

Study Design: A randomized controlled double blinded trial

Place and Duration of Study: Pain clinic Combined Military Hospital [CMH] Rawalpindi, CMH Nowshera, Dermatology Dept. Military Hospital [MH] Rawalpindi, Department of Medicine, Surgery CMH Nowshera Feb 2009 to Feb 2010

Material and Methods: Fifty patients with post herpetic neuralgia [PHN], 10 patients with trigeminal neuralgia and 20 patients with nerve entrapment pain were included in the study. For each type of neuropathic pain, the patients were randomly divided into two groups. Group [B] received nerve blocks using 0.5% bupivacaine and group [BS] received nerve blocks using 0.5% bupivacaine and streptomycin Igm combination. A series of four nerve blocks on alternate days were given. VAS [Visual Analogue Scale] was recorded at four, eight and twelve weeks after the last nerve block. Mean baseline VAS and at 12 weeks post treatment in groups B and BS were compared for pain relief and the mean VAS at 12 week post treatment in both the groups was compared for the difference in pain relief between the two groups. Students't test was used for statistical analysis utilizing SPSS 10 versions

Results: Post herpetic neuralgia - group [B]: at 12 weeks, mean VAS was 5.75 in gp [B] and 2.26 in gp [BS] respectively. Nerve entrapment pain- group [B] at 12 weeks, mean VAS was 6.62 whereas in group [BS] VAS was 1.33. Trigeminal neuralgia-group [B] At 12 weeks mean VAS was 7.0. gp [BS] mean VAS was 1. Pain relief achieved was excellent

Conclusion: Streptomycin and bupivacaine combination is an effective modality to manage neuropathic pain. The pain relief achieved by streptomycin-bupivacaine combination is superior to that achieved with bupivacaine alone

Coronary artery disease and T wave inversions in electrocardiogram at high altitude

To find out the role of coronary artery disease [CAD] as a cause of T wave inversions in electrocardiogram [ECG] in otherwise healthy soldiers who were evacuated from high altitude because of chest pain. A prospective observational study. The study was carried out at CMH Skardu from September 2003 to September 2004 fifty-four consecutive patients evacuated from height > 4000 meters [13123 feet] with symptoms of chest pain and electrocardiographic changes of T-wave inversions in a group of leads were included in the study. Echocardiography and Exercise tolerance test [ETT] was performed on all the patients. All of the patients with indeterminate or inconclusive results on ETT underwent coronary angiography at Armed Forces Institute of Cardiology, Rawalpindi. Out of 54 patients, 36 [66.7%] patients had normal exercise tolerance test. In the rest 18 [33.34%] patients coronary angiogram was done and in 04 patients it was reported abnormal. In 02 [3.70%] patients coronary angiogram confirmed coronary artery disease. In 02 patients coronary angiograms were abnormal but there was no evidence of coronary artery disease. T wave inversions at high altitude suggestive of IHD are not true indicators of underlying coronary artery disease