Ultrasound-guided RFA of genicular nerves of knee joint is a good alternative option for patients who are having severe pain and disability from knee osteoarthritis and gives a long-lasting pain relief for more than 6 months.

Introduction:The pain from upper gastrointestinal malignancy leads to considerable morbidity. The celiac plexus and splanchnic nerve neurolysis are good therapeutic options. Although splanchnic nerve neurolysis less frequently performed, but it has an edge over celiac plexus as it can be performed in patients with altered celiac plexus anatomy by enlarged lymph nodes.Methods:The fluoroscopy-guided splanchnic nerve neurolysis was done in about 21 patients with intractable upper abdominal pain with pain intensity of ≥7 in numerical rating scale (NRS) from upper gastrointestinal cancers with distorted celiac plexus anatomy from enlarged celiac lymph nodes as seen by computed tomography scan after positive diagnostic splanchnic nerve neurolysis. The demographic features, pain intensity, daily opioid dose, functional status and quality of life was measured at baseline and 1 week, 1 and 3 months after the procedure.Results:There was a significant improvement in pain intensity, opioid requirement, functional status, and physical components quality of life after the neurolysis (P < 0.05) and this improvement had continued till 3 months. There were also more than 50% reduction in pain intensity and significant decrease in opioid requirement in all the patients after neurolysis.Conclusion:The fluoroscopy-guided splanchnic nerve neurolysis results significant pain relief, decrease in opioid intake, improvement in functional status, and quality of life for up to 3 months in upper abdominal pain from gastrointestinal cancers in patients with distorted celiac lymph node anatomy not amenable to celiac plexus neurolysis.

Meralgia paresthetica is a rare sensory entrapment neuropathy which leads to burning, tingling and numbness in the antero-lateral aspect of thigh. Mostly it runs a benign course, and responds to conservative measures. We present a case series of six patients with intractable meralgia paresthetica with severe pain over antero-lateral thigh along the distribution of lateral cutaneous nerve of thigh which was further confirmed by nerve conduction study. These patients did not respond to the oral antineuropathic medications. The two successive diagnostic lateral femoral cutaneous nerve block not only had confirmed the diagnosis but also provided pain relief for a few days. Then the ultrasound-guided lateral femoral cutaneous nerve neurolysis was done using 50% alcohol. In all the patients, there were more than 50% decrease in pain intensity and improvement in quality of life after the procedure, and the relief and improvement were maintained for up to 12 weeks. This case series shows ultrasound-guided lateral femoral cutaneous nerve neurolysis is a safe and effective treatment for intractable meralgia paresthetica and also provides prolonged pain relief and is a good option in avoiding the surgery. Summary pointsThe literature on neurolysis is rare, with only few case reports. This is the first case series on this topic, and it will greatly improve the evidence that ultrasound-guided neurolysis can also be used for intractable meralgia paresthetica patients who do not respond to conservative measures before proceeding to surgery.

Ultrasound-guided alcohol neurolysis is a good alternative for patients having severe pain from knee osteoarthritis and provides significant pain relief for more than 6 months.

Patient safety, improved quality of care, and better patient satisfaction and functional outcomes are currently the topmost priorities in regional anaesthesia (RA) and all advancements in RA move in this direction. Ultrasonography-guided central neuraxial and peripheral nerve blocks, intracluster and intratruncal injections, fascial plane blocks, diaphragm-sparing blocks, use of continuous nerve block techniques, and continuous local anaesthetic wound infiltration catheters are now topics of popular clinical interest. The safety and efficacy of nerve blocks can be improved with the help of injection pressure monitoring and the incorporation of advanced technology in the ultrasound machine and needles. Novel procedure-specific and motor-sparing nerve blocks have come up. The anaesthesiologist of the current era, with a good understanding of the sonoanatomy of the target area and the microarchitecture of nerves, along with the backup of advanced technology, can be very successful in performing RA techniques. RA is rapidly evolving and revolutionising the practice of anaesthesia.

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We were interested in applying the appealingly safer yet equally effective alternative suggested to thoracic paravertebral block – the erector spinae plane (ESP) block by Forereo1 to our clinical practice. ESP block is being used as an effective analgesic technique in abdominal and thoracic procedures like video-assisted thoracoscopic surgery (VATS) and bariatric surgeries.2,3 It is a very safe and effective analgesic technique with minimal potential for major complications. ESP block proved to be effective for analgesia in breast surgeries as well.

The Adjuvants added to local anaesthetic increases the duration of post-operative analgesia and decreases the analgesic requirement in post-operative period. The study was conducted with the intent of comparing post-operative analgesic effect of Dexamethasone and Dexmedetomidine in ultrasound guided Brachial Plexus Block. A prospective, randomised, double blind study to compare post-operative analgesic effect of Dexamethasone and Dexmedetomidine as adjuvant to 0.2% Ropivacaine in Ultrasound Guided Brachial Plexus Block. 60 patients belonging to ASA I and ASA II scheduled for upper limb surgeries were included in the study after taking informed consent. Group A received 20ml of 0.2% Ropivacaine with 8mg of Dexamethasone. Group B received 20ml of 0.2% Ropivacaine with 50 µg of Dexmedetomidine. Our primary objective was to compare the time to first request for analgesia in both the groups. Secondary objective was to compare duration of sensory and motor block in post-operative period and to compare overall requirement for analgesia in 24 hours in both the groups. The mean duration of motor block in Dexamethasone group was 635.47 ± 26.29 minutes and in Dexmedetomidine group was 827.47 ± 54.62 minutes. Similarly, mean duration of sensory block was 681.5 ± 27.19 minutes in Dexamethasone group and 877.17 ± 52.85 minutes in Dexmedetomidine group. The mean duration of time to first rescue analgesic was 709.67+18.47 minutes in dexamethasone group and 910.2 ± 51.66 minutes in Dexmedetomidine group. Total analgesia given had significant statistical difference of 0.004 between the two groups, with mean of 1.23 ± 1.17 in Dexamethasone group and 0.4 ± 0.56 in Dexmedetomidine. However, at 2hr, 4hr, 8hr, 12hr, 18hr and 24 hr the difference in VAS scores was significant (p value &#60;0.0001). Dexmedetomidine is better than Dexamethasone in prolonging duration of analgesia of the Brachial plexus block.