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( Abhijit S. Nair ),( Praveen Kumar Kodisharapu ),( Poornachand Anne ),( Mohammad Salman Saifuddin ),( Christopher Asiel ),( Basanth Kumar Rayani ) 대한통증학회 2018 The Korean Journal of Pain Vol.31 No.2
The Epidural blood patch is considered the gold standard for managing postdural puncture headache when supportive measures fail. However, it is a procedure which can lead to another inadvertent dural puncture. Other potential adverse events that could occur during a blood patch are meningitis, neurological deficits, and unconsciousness. The bilateral greater occipital nerve block has been used for treating chronic headaches in patients with PDPH with a single injection. This minimally invasive, simple procedure can be considered for patients early, along with other supportive treatment, and an epidural blood patch can be avoided. (Korean J Pain 2018; 31: 80-6)
( Abhijit S. Nair ),( Basanth Kumar Rayani ) 대한통증학회 2017 The Korean Journal of Pain Vol.30 No.2
The sphenopalatine ganglion (SPG) is a parasympathetic ganglion, located in the pterygopalatine fossa. The SPG block has been used for a long time for treating headaches of varying etiologies. For anesthesiologists, treating postdural puncture headaches (PDPH) has always been challenging. The epidural block patch (EBP) was the only option until researchers explored the role of the SPG block as a relatively simple and effective way to treat PDPH. Also, since the existing evidence proving the efficacy of the SPG block in PDPH is scarce, the block cannot be offered to all patients. EBP can be still considered if an SPG block is not able to alleviate pain due to PDPH. (Korean J Pain 2017; 30: 93-7)
Does subepineural injection damage the nerve integrity? A technical report from four amputated limbs
( Sandeep Diwan ),( Abhijit Nair ),( Parag Sancheti ),( André Van Zundert ) 대한통증학회 2021 The Korean Journal of Pain Vol.34 No.1
Local anesthetic (LA) injection outside the sheath in epineural or paraneural connective tissue is considered safe practice among regional anesthesiologists. There is limited evidence as to whether neurological complications occur if LA is injected inside the sheath (subepineural - intraneural). We performed ultrasound guided injections at the level of undivided sciatic nerve in four amputated lower limbs. In two specimens, LA was injected in epineural connective tissue (paraneural tissue) and in another two specimens by penetrating the outer nerve sheath (hyperechoic epineurium). Ultrasonography demonstrated an increase in the size of nerve and macroscopic findings revealed fascicular tracings with sub-epineural injections. Limbs were sent for histological analysis in formalin containers. Pathologist performed the analysis which demonstrated an intact perineurium and a breach in the epineurium. We conclude that sub-epineural injections are unsafe and injection should be done in paraneural tissue to ensure safety and avoid unwanted neurological sequelae after the block.
( Rajendra Kumar Sahoo ),( Abhijit S. Nair ) 대한통증학회 2015 The Korean Journal of Pain Vol.28 No.4
Anterior cutaneous nerve entrapment syndrome (ACNES) is one the most common cause of chronic abdominal wall pain. The syndrome is mostly misdiagnosed, treated wrongly and inadequately. If diagnosed correctly by history, examination and a positive carnett test, the suffering of the patient can be relieved by addressing the cause i.e. local anaesthetic with steroid injection at the entrapment site. Conventionally, the injection is done by landmark technique. In this report, we have described 2 patients who were diagnosed with ACNES who were offered ultrasound guided transverses abdominis plane (TAP) injection who got significant pain relief for a long duration of time. (Korean J Pain 2015; 28: 284-286)
Subcoracoid tunnel block as an alternative infraclavicular brachial plexus approach -a case series-
Sandeep Diwan,Divya Sethi,Avinash Gaikwad,Parag Sancheti,Abhijit Nair 대한마취통증의학회 2020 Korean Journal of Anesthesiology Vol.73 No.5
Background: Magnetic resonance neurography shows the brachial plexus cords in the subcoracoid tunnel beneath the pectoralis minor. With an ultrasound scan along the brachial line, the brachial plexus cords in the subcoracoid tunnel can be targeted using an inplane needle approach. We describe this new approach to the infraclavicular block called the “subcoracoid tunnel block.” Case: Twenty patients were administered with the ultrasound-guided subcoracoid tunnel block for the below-elbow surgery. The contact of the needle tip with cords was visible in all 20 patients. With neurostimulation, the posterior cord was identified in 11 (55%) and medial cord in 9 (45%) patients on the first needle pass. The subcoracoid tunnel block was successful in 16 patients (80%). Conclusions: Our case series shows that the subcoracoid tunnel block is an excellent alternative technique for the infraclavicular block. Its advantages include better needle-cord visibility and easy identification of the brachial plexus cords.
John J. Finneran IV,Rodney A. Gabriel,Matthew W. Swisher,Allison E. Berndtson,Abhijit Nair,Todd W. Costantini,Brian M. Ilfeld 대한마취통증의학회 2020 Korean Journal of Anesthesiology Vol.73 No.5
Background: Rib fractures are a common injury in trauma patients and account for significant morbidity and mortality within this population. Local anesthetic-based nerve blocks have been demonstrated to provide significant pain relief and reduce complications. However, the analgesia provided by these blocks is limited to hours for single injection blocks or days for continuous infusions, while the duration of this pain often lasts weeks. Case: This case series describes five patients with rib fractures whose pain was successfully treated with cryoneurolysis. Conclusions: Ultrasound-guided percutaneous cryoneurolysis is a modality that has the potential to provide analgesia matching the duration of pain following rib fractures.