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

Brain death and related issues

Concerns about the erroneous diagnosis of death and premature burial have been expressed from times immemorial. Patients with brain stem death have absolutely no chance of recovery. brain death is considered at par with death in most of the countries. General public in most parts of the world shows reluctance to accept this concept due to different social, cultural and religious backgrounds and state of literacy and awareness. The criteria for the diagnosis of brain death have been established which include certain pre-conditions, exclusions and tests of the brain stem function. These criteria are universally accepted. The criteria in children are somewhat different from the adults. The subject is intimately related with organ transplantation. If the patient is registered as organ donor or the family consents, organs can be harvested from brain dead patients for transplantation. Pakistan is amongst the few countries where no legislation exists to accept brain death as being at par with death of an individual, and to facilitate and regulate, cadaveric organ donation and transplantation. This is a review Article