We undertook a randomised, double-blind, placebo-controlled study to compare the analgesic efficacy of pre-operative stellate ganglion block on postoperative pain relief after upper limb orthopaedic surgery. Patients were administered a 3-ml injection during ultrasound-guided stellate ganglion block; 15 patients received lidocaine 2% and 15 patients received 0.9% saline. Following the block, all patients received standardised general anaesthesia. Postoperative analgesia included regular intravenous diclofenac, paracetamol and patient-controlled analgesia with tramadol for 24 h. Patients were observed at 0, 2, 4, 6, 8, 12 and 24 h after surgery for tramadol consumption, cardiovascular variables and visual analogue scale pain scores at rest and on movement. The mean (SD) hourly tramadol consumption was significantly reduced in the lidocaine group compared with the saline group at 4 h (8.0 (10.1) mg vs 28.0 (12.6) mg, respectively; p = 0.001), 6 h (5.3 (10.8) mg vs 17.3 (12.7) mg, respectively; p = 0.013) and 8 h (5.3 (11.8) mg vs 21.3 (9.1) mg, respectively; p = 0.001). The cumulative 24-h tramadol consumption was 97.3 (16.6) mg in the lidocaine group and 150.6 (26.0) mg in the saline group (p = 0.001). There were significant differences in the pain visual analogue scale at rest at two time points; at 4 h the median (IQR [range]) visual analogue scale scores were 4 (4-6 [2-8]) in the lidocaine group and 5 (4-6 [2-7]) in the saline group (p = 0.03), and at 6 h visual analogue scale scores were 3 (3-4 [3-6]) and 4 (4-6 [2-7]), respectively (p = 0.04). Pain visual analogue scale on movement was lower in the lidocaine group at all time intervals compared with the saline group, but this did not reach statistical significance. The present study has demonstrated a postoperative tramadol-sparing and analgesic effect of pre-operative stellate ganglion block in patients undergoing upper limb orthopaedic surgery under general anaesthesia.

Cancer pain is still one of the most feared entities in cancer and about 75% of these patients require treatment with opioids for severe pain.The cancer pain relief is difficult to manage in patients with episodic or incidental pain, neuropathic pain, substance abuse and with impaired cognitive or communication skills. This non-systematic review article aims to discuss reasons for under treatment, tools of pain assessment, cancer pain and anxiety and possibly carve new approaches for cancer pain management in future. The current status of World Health Organization analgesic ladder has also been reviewed. A thorough literature search was carried out from 1998 to 2010 for current status in cancer pain management in MEDLINE, WHO guidelines and published literature and relevant articles have been included.

Introduction: Suicide is a major public health concern and it is one of the commonest Psychiatric emergencies. Suicide rates are increasing and have become a global concern with more than 600,000 suicidal attempts every year in the United States, alone. There is no national data available for Nepal. This hospital based study may help in understanding about the cause and methods of suicide attempts. Objective: The aim of the present study was to assess the (i) methods and precipitating cause for attempted suicide (ii) to study the relationship between major socio-demographic variables and attempted suicide. This study may be helpful in formulating suicide prevention strategies at different levels. Methods: Cross-sectional study in a tertiary level hospital. Consecutive 100 cases of attempted suicide coming in contact to an investigating team were evaluated for methods opted for attempting suicide and underlying cause was explored. Demographic variables were recorded and analysed. Results: Majority of the suicide attempters (67%) were less than 35 years of age, and female outnumbered male. Sixty one percent of the subject belonged to rural background. Out of 100 suicide attempters 40% of them have completed SLC and majority of them were students. Fifty-four percent of the sample consumed pesticides and 25% of the cases used highly lethal means. Majority of the persons (58%) had psychiatric co morbidities in which depression was the commonest. Interpersonal conflict accounted for 18% of the cases followed by marital problems (13%) as triggering factors of attempted suicide. Conclusion: Majority of the suicide attempters were young and having psychiatric disorders. Most of the attempters were from rural areas. Keywords: Attempted suicide; psychiatric co morbidities; Interpersonal conflict. DOI: http://dx.doi.org/10.3126/hren.v9i3.5584   HR 2011; 9(3): 162-167

Intermittent ACB allowed significantly reduced consumption of morphine for 24 h in the post-operative period compared with continuous ACB when identical doses of ropivacaine were used in each group.

Abstract

This case report highlights problems during right internal jugular vein cannulation resulting from high back pressure and flow from superior vena cava obstruction in steroid-induced mediastinal lipomatosis. Other anesthetic considerations in mediastinal lipomatosis are also discussed.

Introduction: Ageing is a normal phenomenon. Various studies shows that there is a sharp rise in the elderly population in the last few years. Prevalence of depression in elderly is found to around 13% in the community sample in various countries. There is a dearth of study related to psychiatric illness in elderly in Nepal. This study was aimed to find the prevalence of depression in elderly and see for various factors associated with elderly depression. Material And Method: This was a cross-sectional study conducted at Siddharthnagar Municipality, Bhairahawa, Rupandehi. 316 elderly were selected by using systematic random sampling technique. A Semi- structured interview schedule was developed to collect Socio-demographic data. The Short Form Geriatric Depression Scale (SF-GDS) was used to find out the prevalence of depression among elderly people. Ethical Approval was obtained from the Institutional Review Committee, Chitwan Medical College and permission was obtained from Siddharthnagar Municipality, Bhairahawa, Rupandehi. The collected data was entered in Epidata 3.1 and the data was exported and analyzed in IBM SPSS 20. Results: There were a total of 316 samples in this study. The mean age of respondents was 68.47 years of age. Majority of the respondents (54.1%) were female and living in joint Family (72.2%). Almost 45.9% respondents were from upper caste groups, 90.5% of respondents were Hindus. Among the married (100%) respondents, 54.6% of respondents were living with spouse and 3.2% were divorced and separated from spouse. Depression was present in 49.4% of respondents were depressed. Among depressed respondents, 46.7% of respondents were having mild depression, 39.2% moderate depression and 14.1% severe depression. Conclusion: The finding of this study concluded that depression among elderly people was a substantial problem in Siddharthnagar Municipality, Bhairahawa, Rupandehi.

Plantar fasciitis (PF) is the most common cause of chronic heel pain which may be bilateral in 20 to 30% of patients. It is a very painful and disabling condition which can affect the quality of life. The management includes both pharmacological and operative procedures with no single proven effective treatment modality. In the present case series, we managed three patients with PF (one with bilateral PF). Following a diagnostic medial calcaneal nerve (MCN) block at its origin, we observed reduction in verbal numerical rating scale (VNRS) in all the three patients. Two patients has relapse of PF pain which was managed with MCN block followed with pulsed radio frequency (PRF). All the patients were pain-free at the time of reporting. This case series highlights the possible role of combination of diagnostic MCN block near its origin followed with PRF as a new modality in management of patients with PF.