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

Prevention of hypotension in caesarean delivery under spinal anaesthesia; the combination of modified supine wedged position, crystalloid co-hydration and prophylactic atropine

To evaluate the efficacy of a modified supine wedged position with table tilt, crystalloid co hydration and prophylactic intravenous atropine in the prevention of hypotension in caesarean delivery under spinal anaesthesia. Phase 2 clinical trial. Place and Duration of Study: PAF Hospital Masroor Karachi and PAF Hospital Rafiqi Shorkot Oct 2005 - April 2006. 40 parturients undergoing elective caesarean section under spinal anaesthesia were studied. Lactated Ringer's solution 10 ml/kg was administered over 10min.After Spinal in the sitting position with a 25-gauge Quincke needle using0.75% hyperbaric bupivacaine [12.75-15mg], the parturient was placed in the modified supine position with table tilt .Atropine 10microg/kg was given i/v. The baseline blood pressure and heart rate in each parturient before intervention [crystalloid co hydration, spinal, modified supine wedged position and i/v atropine] were taken as control and evaluated against the values after the intervention at different time intervals. Thirty nine out of forty patients completed the study. Mean upper sensory level was T4 at 6min post spinal. The mean spinal to delivery time was less than 12 min.5% of the parturients developed hypotension at 2 min post spinal. The mean heart rate was 96/min. The mean, systolic and diastolic blood pressures remained close to the base line values at 4, 6, 10, 12, 16 and 20 min post spinal. Modified supine wedged position with table tilt, crystalloid co-hydration and prophylactic i/v atropine is an effective combination technique which prevents spinal induced hypotension in caesarean delivery