Unilateral Block Research Articles

Stellate Ganglion Block Relieves Long COVID-19 Symptoms in 86% of Patients: A Retrospective Cohort Study.

Post-COVID-19 condition, also known as long COVID-19 syndrome and post-acute sequelae of SARS-CoV-2, encompasses an array of symptoms that persist well beyond the initial phase of the viral infection. These symptoms can range in intensity, from mild and manageable to severe and incapacitating.Due to the evolving nature of the SARS-CoV-2 pandemic, treatment protocols for the illness are in a constant state of evolution. The early stage of long COVID-19 syndrome contributes to a dearth of treatment protocols based on empirical evidence, while the absence of a conclusive pathophysiological understanding further complicates the development of such protocols. Current treatment regimens include homeopathic medicine, specialist system-focused treatments, infusion therapies, hyperbaric oxygenation, antivirals, and polypharmacy. The physiological, psychological, and societal impact of long COVID-19 cannot be approached casually and must govern the intensity with which the healthcare community approaches the treatment of long COVID-19 syndrome. In this 41-patient cohort study from a chronic pain management practice, the use of either unilateral or bilateral stellate ganglion block (SGB) was explored to manage symptoms associated with long COVID-19 syndrome. Results indicated that a substantial proportion of patients (86%) experienced a reduction of their symptoms following SGB treatment.

A PROSPECTIVE RANDOMIZED INTERVENTIONAL STUDY TO DETERMINE THE INFLUENCE OF SPINAL FLEXION VERSUS EXTENSION IN THE LATERAL DECUBITUS POSITION ON THE UNILATERALITY OF SPINAL ANESTHESIA USING HYPERBARIC BUPIVACAINE FOR ELECTIVE UNILATERAL LOWER LIMB SURGERIES

Objective: A restricted sympathetic block during spinal anesthesia may minimize hemodynamic changes and advantageous in view of maintaining stable cardiovascular profile through intraoperative period. Methods: This prospective randomized interventional study was conducted on a total of 150 patients of either sex aged 20-50 years of American Society of Anesthesiologists grades 1 and 2 were randomly allocated in two groups (75 in each group).Using a 25-gauge Quincke spinal needle, 7.5 mg of 0.5% hyperbaric bupivacaine was injected over a period of 80s at L3-L4 interspace in both groups. Patients were kept in flexion or extension according to belonging groups: Group A (flexion) or Group B (extension) after drug administration for15 min of lateral decubitus position, then patients were turned to supine position. Results: Strict unilateral sensory and motor block at 15 min was noted in Group A 45 patients (60%) and 25 patients (33.33%) in Group B (p=0.002*). At 60 min, there was no significant sensory unilaterality between the groups (p=0.987). At 60 min, 30 patients (40%) in Group A and 14 patients (18.66%) in Group B had strict unilateral motor block (p=0.007*). Highest achieved sensory level on nondependent side was T10 in Group A and T8 in Group B, whereas it was T6 in Group A and T5 in Group B on dependent side. Conclusion: For unilateral spinal anesthesia, spinal flexion position provided better strict unilaterality and restricted sympathetic blockade than spinal extension position.

Evaluation of paravertebral blocks in improving post-procedural pain and decreasing hospital admission after microwave ablation of liver tumors

Although ablations are performed with conscious sedation or general anesthesia, microwave ablations can be painful post procedure. Newer analgesic modalities, including regional blocks, have promoted the proliferation of less invasive anesthesia care for ablative procedures. This study evaluates whether bilateral paravertebral blocks reduce the need for additional analgesics in comparison to unilateral blocks in microwave ablations. In this retrospective study, individuals undergoing microwave ablation who underwent unilateral versus bilateral nerve blocks at a single institution from 2017 to 2019 were compared. Categorical variables were analyzed using Pearson’s chi-squared tests. Comparisons of means were completed using multiple T-tests corrected using the Holm-Sidak method with alpha = 0.05. Regression modeling was used to identify factors related to increased MME (milligram morphine equivalent) usage and post-procedure admission rates. A total of 106 patients undergoing 112 liver MWA procedures were included in this analysis, with patients receiving either a bilateral or unilateral block. Pre-procedural characteristics demonstrated no significant differences in age or gender. Bilateral blocks were associated with decreased usage of gabapentin (14% vs. 0%, p = 0.01) and a lower rate of post-procedure admissions (OR 0.23, p = 0.003). Therefore, when using paravertebral blocks, bilateral blocks are superior to unilateral blocks, as demonstrated by decreased rates of hospital admission and reduced use of systemic neuropathic pain medication. Additionally, reducing post-procedural MME may reduce the rate of admission to the hospital.

Ultrasound Guided Fascia Iliaca Compartment Block versus Three in One Block for Post Operative Analgesia in Patients Undergoing Hip and Knee Replacement Surgeries

Abstract Background Patients undergoing total hip and knee arthroplasty experience substantial and sustained postoperative pain. Inadequate analgesia may impede physical therapy and rehabilitative efforts and delay hospital dismissal. Peripheral nerve blockade of the lumbosacral plexus has emerged as an analgesic approach. In several studies, unilateral peripheral block provided quality of analgesia and functional outcomes similar to those of continuous epidural analgesia and superior to those of systemic analgesia, but with fewer side effects because of their opioid-sparing properties. Peripheral nerve block techniques may be the optimal analgesic method following total joint arthroplasty. Aim of the Work To compare postoperative analgesia between ultrasound-guided FICB and three in one nerve block. Study design a prospective randomized double-blinded study. Patients and Methods The study was conducted on 80 randomly chosen patients from 21 to 65 years old in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups, each group consisted of 40 patients group I and group II. After preoperative assessment and obtaining baseline vital data, all patients received spinal anesthesia. Patients in the group I received FICB (35-40 ml of 0.25% bupivacaine). Patients in group II received three in one bock (35-40 mL of bupivacaine 0.25%). Results Both FICB and three in one block provided good quality of postoperative analgesia and patient satisfaction as evidenced by low VAS and low postoperative rescue analgesic requirements. Both techniques provided equal sensory blockage of femoral nerve, obturator nerve, and genitofemoral nerve, but sensory blockage of LFC nerve was demonstrated in 92.5% patients in FICB and 62.5% of patients in three in one block, which was significantly lower (p-value <0.001 HS). VAS at 12 hours after surgery during movement of 3.68 ± 2.77 in the FICB group and 4.90 ±0.18 in the 3 in 1 group were statistically significant (P value = 0.007). Conclusion The FICB provides a high degree of sensory blockade of the LFC nerve and improves analgesia when continuous passive motion is initiated in the early postoperative period; also, it is easy to perform, reliable and does not threaten any vital organ. Thus, FICB can be recommended as an alternative to three in one block for the treatment of pain after hip and knee arthroplasty.

Unilateral Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy for Pain Control Comparison with Conventional Port Site and Peritoneal Infiltration

Objective: To compare image-guided unilateral subcostal transversus abdominis plane (STA) block with infiltration of local anaesthetic both port site and peritoneal for post-operative analgesia for laparoscopic gall bladder surgery.
 Study Design: Quasi-experimental study
 Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Quetta Pakistan, from Nov 2018 to Apr 2019.
 Methodology: The study sample (n=80) was divided into two Groups, one for image-guided subcostal transversus abdominis plane block and the other for peritoneal and port site infiltration of local anaesthetic. Anaesthesia was induced with intravenously administered propofol, atracurium, nalbuphine, and intraoperative non-opioid analgesia with ketorolac following which endotracheal intubation was done. The level of abdominal pain was assessed.
 Results: The mean opioid consumption at the 24th post-operative hour was 22.75±8.55 in Group-A and 43.20±11.80 in GroupB. Mean total opioid consumption was 111.40±35.99 and 218.90±63.91 in Group-A and B, respectively. The mean VAS score at the 24th post-operative hour was 1.20±0.96 in Group- A and 3.12±1.63 in Group-B. The results showed a significant mean difference between opioid consumption and VAS pain score at the 24th hour (p<0.05).
 Conclusion: The unilateral Subcostal transversus abdominis plane block proved a superior alternative to port site and peritoneal infiltration combined for laparoscopic cholecystectomy.

Comparison of dexmedetomidine and clonidine as an adjuvant to levobupivacaine in transversus abdominis plane (TAP) block for postoperative analgesia following inguinal hernia repair

Postoperative analgesia for inguinal hernia procedures can be provided safely and effectively with USG guided TAP blocks. In the TAP block following inguinal hernia repair, we compared the analgesic effectiveness of dexmedetomidine and clonidine.: Seventy four patients undergoing inguinal hernia repair under spinal anesthesia were randomly divided in to Group LD (n=37) and Group LC (n=37). Patients in Group LD received a unilateral USG-guided TAP block with 0.5% levobupivacaine 18ml and dexmedetomidine 1 μg/kg in NS to make a total 20ml at the conclusion of surgery after regression of sensory block to the T10 dermatome, whereas patients in Group LC received 0.5% levobupivacaine 18ml and clonidine 1 μg/kg. Duration of postoperative analgesia, quality of analgesia (VAS), total rescue analgesic consumption in 24 hours and adverse effects were noted.Time for the initial application of rescue analgesia took substantially longer in Group LD (1006.49± 29.89 min) than in Group LC (512.35 ±27.14 min) (p ≤0.0001). At 8h, 16h, and 20h postoperatively, Group LD had a significantly lower VAS score both at rest and during hip flexion. It was discovered that Group LD had considerably decreased overall analgesic consumption. Incidence of postoperative side effects was comparable between two groups.: In comparison to clonidine, TAP block with dexmedetomidine as an adjuvant to levobupivacaine greatly prolongs postoperative analgesia and lowers 24-hour analgesic use.

EFFICACY OF THORACIC SEGMENTAL SPINAL ANESTHESIA ALONG WITH UNILATERAL ERECTOR SPINAE BLOCK IN PATIENTS UNDERGOING UNILATERAL MODIFIED RADICAL MASTECTOMY AND AXILLARY DISSECTION: A NOVEL MULTICENTRIC STUDY

Objectives: The aim of the study was to find out the efficacy of thoracic segmental spinal anesthesia combined with unilateral erector spinae block in patients undergoing unilateral modified radical mastectomy and axillary lymph node dissection Methods: This was a prospective cohort study in which 40 patients with carcinoma breast undergoing modified radical mastectomy with axillary dissection under thoracic segmental spinal anesthesia combined with unilateral erector spinae block were included on the basis of a predefined inclusion and exclusion criteria. Erector spinae plane block was given at T5 level and thoracic spinal anesthesia was then given at T5–T6 level in the same position by median or paramedian technique. Patients were assessed for severity of pain by visual analog scale score till 24 h of surgery. Results: The mean age of studied cases was found to be 44.12±10.04 years. Mean weight of studied cases was 54.38±9.8 kg, whereas mean duration of surgery was found to be 98.24±16.86 min. The most common American Society of Anesthesiologists (ASA) grade to which patients belonged was found to be ASA III (55%) followed by ASA II (30%) and ASA I (15%). Eleven patients required rescue analgesia within first 24 h after surgery and mean doses of rescue analgesia in 1st 24 h after surgery was found to be 0.92±0.48. Four (10%) patients developed hypotension, whereas three (7.5%) patients had bradycardia. However, all these 7 (17.5%) had transient bradycardia or hypotension which could be managed by IV Atropine or IV mephentermine and fluid bolus. Conclusion: Thoracic segmental spinal anesthesia combined with unilateral erector spinae block is an excellent option for patients undergoing modified radical mastectomy with axillary dissection.

Insignificant influence of the intertransverse process block for major breast cancer surgery: a randomized, blinded, placebo-controlled, clinical trial

IntroductionThe intertransverse process (ITP) block mimics the thoracic paravertebral block and allegedly ameliorates hemithoracic postoperative pain. However, concerning major reconstructive breast cancer surgery the modality has never been tested against...

Evaluation and Management of Mechanical Infertility Using Minimal Access Surgery

Introduction: Tubal and peritoneal pathologies are one of the most common causes responsible for female infertility corresponding to 30%–40% of cases. The use of combined hysteroscopy and laparoscopy (HL) has now become a gold standard in the diagnosis and subsequent treatment of these pathologies. Aim of the Study: (1) Evaluation of infertile females for tubal and uterine pathologies using combined HL as a diagnostic aid. (2) To find out the feasibility of providing therapeutic management concurrently. Materials and Methods: This study was conducted from 2018 to 2019 on 100 married females in the age group of 20–45 years with primary or secondary infertility of > 1-year duration after ruling out male causes and hormonal causes of infertility. Laparoscopy and hysteroscopy were performed in a single session; methylene blue dye testing was done. Any relevant positive findings on hysterolaparoscopy were noted, and the incidence of different lesions was calculated. Surgical procedures wherever possible were carried out and tabulated accordingly. Results: Out of all patients subjected to combined HL, positive findings were noted in 76% of the cases. The most common hysteroscopic pathology in our patients was intrauterine adhesions (9.2%), followed by polyp (7.9%) and septum (6.6%). Similarly, on laparoscopy, the common findings were adhesions (23.7%), endometriosis (21.1%), myomas (17.1%), and hydrosalpinx (13.2%). Unilateral tubal block was seen in 15.8% and bilateral tubal block in 13.2% of the patients. Hysteroscopic procedures were done in 40.8% of the patients and laparoscopic procedures in 60.5% of the patients. Conclusion: From our study, we concluded that combined HL serves as an important diagnostic as well as a therapeutic modality in female infertility. Direct visualization of the uterine cavity and the ability to manipulate uterus and adnexa and perform any procedure required l(cannulation, septal resection, adhesiolysis etc.) all in a single session makes combined HL a far more superior tool for evaluation and treatment of infertility.

Comparison of Hysterosalpingography and Laparoscopy in the Evaluation of Infertility: A Prospective Study.

Worldwide one of the major problems of human reproduction that haunts men and women is infertility. Hysterosalpingography (HSG) and laparoscopy (LS) are the two most important modalities to evaluate infertility. Our aim is to compare the efficacy of both. This is a prospective study. One hundred and five females of both primary and secondary infertility together were included. Detailed history, examination and routine investigations were carried out. Tuberculosis polymerase chain reaction (TBPCR) was made from endometrial biopsy sample for all patients. Ovulation study was done by transvaginal ultrasonography. Hysterosalpingography and diagnostic laparoscopy were done. Out of 105 infertile patients, 51.42% were in 26-30years group. 52.3% were from lower economic group. 55.23% presented between 1 to 5years of infertility. Twelve patients had used contraception in the past. Sixteen patients were serologically positive. Twenty-nine patients were with positive TBPCR among 105 females. Fifty-four and fifty-six patients had patent tubes by HSG and laparoscopy, respectively. Uterine filling defects and congenital anomalies could be detected four times more by HSG than by laparoscopy. TO mass was detected only by laparoscopy. Bilateral spill was present in 66.6% by HSG and 67.6% by laparoscopy and unilateral spillage in 22.8% and 21.9%, respectively. The sensitivity, specificity and accuracy of HSG in predicting unilateral block taking laparoscopy as gold standard are 85%, 96.4% and 94.2%, respectively, and sensitivity and specificity of bilateral tubal block are 81.8% and 98%, respectively. HSG and laparoscopy are not alternative, but complimentary in diagnosing tubal pathologies. HSG remains as primary screening procedure, but laparoscopy is gold standard.

Analgesic efficacy of ultrasound-guided PECS II and transeversus thoracic plane blocks compared to serratus anterior plane block for modified radical mastectomy: A randomized prospective study

ABSTRACT Background Chronic pain and discomfort after breast cancer surgery could be reduced by improving acute postoperative pain management. Aim The aim is to compare the analgesic effectiveness of ultrasonography (US) guided serratus anterior plane (SAP) block vs combined modified pectoral nerve (PECS II) and transeversus thoracic plane (TTP) blocks by for modified radical mastectomy patients. The study was registered on Clinicaltrials.gov with registration code: NCT04908878 Patients and methods 70 patients were divided into two equal groups (35 each). After induction of general anesthesia, Group I got unilateral us-guided PECS II-TTP blocks on the procedure side. Group II: received unilateral us-guided SAP block on the operation side. The 24 hours’ postoperative morphine consumption (mg) was the primary outcome. Secondary outcomes were VAS score, time to first need for rescue analgesia, patient satisfaction and complications. Results In combined PECS II-TTP blocks there was a significant decrease in the 24 hours’ postoperative morphine consumption [median (IQR); 3 (3, 6) and 9 (9, 12) mg], VAS scores [median (IQR); 3 (2, 3), 3 (3, 4) at 4 hrs. and 3 (3, 3), 3 (3, 5) at 6 hrs. in group I and II respectively] and prolonged time for 1st rescue analgesia [median (IQR); 8 (6, 12) and 6 (4, 8) hrs in group I and II respectively]. While, there were no significant differences between the two groups in intra-operative fentanyl consumption, hemodynamics or complication. Conclusion The PECS II-TTP blocks provide effective and long-lasting postoperative analgesia than SAP block in modified radical mastectomy.

Serum concentrations of local anesthetics after unilateral interpectoral-pectoserratus plane block in breast cancer surgery: a pharmacokinetic study

IntroductionThe ultrasound-guided interpectoral-pectoserratus plane block is a fascial plane block for superficial surgery of the anterolateral chest wall. This technique involves injecting a relatively large volume of local anesthetics (typically...

“COMPARISON OF UNILATERAL VERSUS BILATERAL SPINALANAESTHESIA USING HYPERBARIC BUPIVACAINE WITH CLONIDINE IN INGUINAL HERNIA SURGERY - A RANDOMIZED CONTROL STUDY”

Introduction: Unilateral spinal anaesthesia has advantages over bilateral spinal anaesthesia as it provides a stronger block on the side of surgery and accelerated recovery of the nerve block. There is lower incidence of hypotension and better maintenance of cardiovascular stability and can be a used for high risk patients. Hence this study was done to compare the unilateral versus bilateral spinal anaesthesia with hyperbaric bupivacaine 0.5 % + clonidine in inguinal hernia surgeries with reference to perioperative autonomic, sensory, motor stability, post operative analgesia and minimize hospital stay. Methodology:Aprospective study was done in 100 patients posted for inguinal hernia surgeries in a tertiary care hospital. After approval from the ethical committee of the institute, Pre anaesthetic checkup was done one day prior to the surgery. Patients were evaluated for any systemic diseases and laboratory investigation recorded. The procedure of SAB was explained to the patients and written consent was obtained. Patients were kept in lateral position (on the side of surgery) for 10min for group U & made supine immediately on the OTtable for group B, with 10 degree head down tilt of the table. Chi-square test and t test was used for statistical analysis. Signicance level was set at 0.05. Result Mean age, mean height, mean weight, ASAphysical status classication, Comorbidities and preoperative vitals was comparable in both the groups. Proportion of patients with fall in vitals was signicantly more in group B compared to group U. Conclusions: Unilateral spinal anaesthesia group had lower incidence of hemodynamic changes with respect to bradycardia and hypotension and lower requirement of Mephentermine and Atropine. So adopting a unilateral spinal block producing minimal hemodynamic uctuations would prove benecial.

A comparative study of unilateral vs bilateral spinal anaesthesia using hyperbaric bupivacaine with buprenorphine in unilateral inguinal hernia surgery

Unilateral spinal anaesthesia can be used for inguinal hernia surgery. The advantage is that it provides a stronger block on the side of surgery and accelerated recovery of the nerve block, with better maintenance of cardiovascular stability. Hence it can be a valuable technique for high-risk patients.
 The aim: This randomized controlled trial was designed to evaluate the onset and duration of Sensory and motor block in both unilateral and bilateral spinal anaesthesia and the adverse effects of buprenorphine given intrathecally with 0.5 % bupivacaine for Spinal anaesthesia in patients scheduled for unilateral inguinal hernia surgery.
 Materials and methods: it is a сomparative two group randomized clinical study with 60 patients with 30 patients in Group U (UNILATERAL) and 30 patients in Group B (BILATERAL) is undertaken to study the changes in haemodynamics and side effects. Whereas, within the group (for the unilateral group) comparison of the time taken to reach L1, T12, T10 and the Bromage time between the surgical side and non-surgical side sides of surgery was done.
 Results: T10 -T12 spinal anaesthesia was achieved in both groups; the average time to anaesthetic onset in the unilateral group was 5.27±1.2 min, and in the bilateral, it was 5.90±1.02 min (p-value=0.32). Sensory and motor block lasted longer in the bilateral group when compared to the unilateral group; the incidence of side effects was limited to the occurrence of hypotension and bradycardia in the unilateral group than in the bilateral group. The success rate of unilateral spinal anaesthesia in our study was 100 %.
 Conclusion: Because of haemodynamic stability and faster recovery characteristics of unilateral spinal block, it can be used as a suitable technique in patients with a limited cardiovascular reserve and for outpatient anaesthesia.

Tibial Nerve Block as Treatment of Chronic Foot Pain.

Minimally invasive therapies can alleviate pain and improve walking in individuals with persistent foot and ankle pain. The current study aimed to define the protracted consequences of tibial nerve blocks with steroids for individuals with persistent foot pain and to investigate the link between the thermography of the plantar foot and the beneficial effect of a tibial nerve block with steroids. All patients with chronic foot pain (n = 45) in this cohort underwent a block of the tibial nerve in the Department of Pain Therapy of Pain Clinic De Bilt, Utrecht, Netherlands, within November 2019 to April 2020. The thermographic images of patients were taken before and after injection. Results were retrospectively evaluated after 18 months. In this study, 53% of the patients had pain relief at 7 weeks of follow-up with a unilateral or bilateral block of the tibial nerve. An improvement in walking distance was reported by 22% of the patients. Side effects of the tibial nerve block reported at 7 weeks of follow-up increased pain (5%) and the occurrence of leg cramps (5%) among the treated patients. At 18 months, 45% of the successfully treated feet still had benefits. A difference between the big toe's temperature and the foot's average temperature of less than -0.9°C on thermography before and after the tibial nerve block can predict a beneficial result of therapy. Tibial nerve block provides a safe, minimally invasive treatment option for almost half of the patients with painful feet in this cohort, and when successful, it can last a long term. Thermographic imaging of the plantar foot can predict only to a small extent the beneficial effect of the tibial nerve block with steroids on foot pain. Tibial nerve block should be considered when custom foot orthoses have been inadequate for pain relief or restricted walking distance.

The use of granisetron on bupivacaine induced sciatic nerve block in rats

Purpose The effects of the 5-hydroxytryptamine (5-HT3) receptor antagonists on regional anaesthesia are complex and unclear. The present study was designed to test the hypothesis that granisetron, a selective 5-HT3 receptor antagonist, would decrease the duration of motor block, sensory block, and proprioception in a dose-dependent fashion in a rat model of bupivacaine-induced sciatic nerve blockade. Materials and methods Thirty-eight male Wistar Albino rats that received unilateral sciatic nerve blocks were randomly divided into five experimental groups. Group B received a perineural of 0.3 ml of bupivacaine alone; Group BG800 received perineural 0.3 ml of bupivacaine and 800 µg of granisetron 10 min later; Group BG1200 received perineural 0.3 ml of bupivacaine and 1200 µg of granisetron 10 min later; Group BG1200IP received a perineural 0.3 ml of bupivacaine and an intraperitoneal injection of 1200 µg of granisetron 10 min later; and Group S was sham operated. A blinded investigator assessed motor, sensory and proprioception function every 10 min until the return of normal function. Results The medians for recovery times in Group B, Group BG800, Group BG1200, and Group BG1200IP were 105, 64, 85, and 120 min for motor function, respectively; 80, 64, 84, and 104 min for sensory function; 80, 63, 85, and 108 min were calculated for the proprioception function. The time to the return of normal motor, sensory, and proprioception function was not statistically significantly different between the groups (p > 0.05). Motor block did not develop in any of the rats in Group S. Conclusions Local and systemic application of granisetron was not significantly decrease the duration of bupivacaine induced motor, sensory, and proprioception block of sciatic nerve in rat.

Efficacy of Adding a Distal Level Block to a C2 Level Greater Occipital Nerve Block under Ultrasound Guidance in Chronic Migraine

Abstract Objective: To investigate the benefit of adding a distal level greater occipital nerve (GON) block to the proximal level GON block under ultrasound guidance in patients with chronic migraine (CM) with cutaneous allodynia (CA). Methods: Seventy-eight patients with CM were included. A single US-guided GON block was performed at proximal and distal levels in patients with CM with CA and only at the proximal level in patients with CM without CA. Thirty (38.5%) patients with bilateral pain received bilateral GON blocks, and 48 (61.5%) with unilateral pain received unilateral GON blocks. The patients were evaluated using Numeric Rating Scale (NRS) scores before treatment and 1 and 4 weeks after treatment and through Headache Impact Test-6 (HIT-6) scores before treatment and 4 weeks after treatment. Results: The NRS scores significantly decreased at first and fourth weeks, and the HIT-6 scores significantly decreased at fourth week (p < 0.001) compared with preintervention scores in all groups. No significant difference was found between the groups regarding the postinterventional first and fourth week when the decreases of NRS and HIT-6 scores were compared (p = 0.599). There were no significant differences in the effectiveness of unilateral and bilateral GON blocks (p > 0.001). Conclusion: A single US-guided GON block is an effective and safe treatment option in patients with CM, providing a positive effect on pain and quality of life for 4 weeks. The addition of a distal level GON block to the proximal level GON block provides no extra benefit to patients with CM with CA.

Role of laparoscopy in hysterosalpingography diagnosed fallopian tube blockage in infertile females

Background: Hysterosalpingography (HSG) is routinely used as cost-effective method for the diagnosis of blockage in fallopian tube in infertile females. Laparoscopy involves a surgical procedure use to confirm the findings of HSG as well as has the therapeutic potential to remove the fallopian tube blockage. Aims and Objectives: The present study was aim towards analyzing the role of laparoscopy in HSG diagnosed fallopian tube blockage in infertile females. Materials and Methods: Total 48 infertile female who were diagnosed with the unilateral or bilateral fallopian tube blockage on HSG and planned for the laparoscopy was recruited in the study. Outcomes of the laparoscopy were analyzed. Results: Among total 48 patients, 26 patients (54%) presented with the bilateral blockage and remaining 22 patients (46%) presented with the unilateral blockage. Laparoscopy had a positive response in 20 (40%) patients with bilateral tubal block and 12 (26.7%) patients with unilateral block whereas the blockage remained in 16 (33.3%) cases. HSG was found to be false positive in two of cases. Conclusions: The present study revealed that the laparoscopy has great therapeutic potential in removal of fallopian tube blockage and is therefore affording patients should be advised to undergo laparoscopy. HSG due to low cost and short duration is more justifiable as a first line procedure. Therefore, is it recommended that the patients diagnosed with blockage in fallopian tube on HSG should be counseled for the laparoscopy. However, additional advantages of laparoscopy in diagnosing pelvic pathology should not be overlooked, thus benefits of laparoscopy cannot be replaced as of now.

Diagnostic Laparoscopy to assess tubal and pelvic pathology in patients of subfertility: A retrospective analysis

Aims: To assess the tubal pathology contributing to primary and secondary infertility by laparoscopic examination.
 Methods: The study was carried out in the department of Obstetrics and gynecology, Grande International Hospital. This is a retrospective study conducted in tertiary care hospital over a period of 2 yrs. From 2020 February to 2022 January. All patients with complaints of infertility (primary and secondary) who were admitted, evaluated and operated for infertility in Obstetrics and Gynaecology department of Grande international Hospital.
 Results: Of the 52 patients minimum age was 20 and maximum was 46 with mean age of 30.52±4.885. Thirty eight patients had primary infertility and 14 had secondary. Forty patients had normal uterus while 12 had enlarged uterus. Hydrosalpinx was found in 11.5 % and 30.8% in right and left tube respectively. Pyosalpinx was found in 9.6% and 7.7% in right and left tube respectively. Bilateral tubes were patent in 22 cases while bilateral blocked tube was found in 13 cases so rest 17 cases had unilateral tubal block. Pelvic adhesions were found in 44.2 % cases. Most of them were associated with endometriosis (15.4%) followed by ovarian cyst (11.5%) and fibroid uterus (11.5%).
 Conclusions: Majority had normal tubal pathology followed by edematous tube, hydrosalpinx and pyosalpinx. Endometriosis, fibroid and ovarian cyst were commonly associated conditions.

Unilateral Right-Sided Ultrasound-Guided Erector Spinae Plane Block for Post-Laparoscopic Cholecystectomy Analgesia: A Randomized Control Trial.

Post-laparoscopic cholecystectomy (LC) pain control is still an issue postoperatively. We investigated the effectiveness of the unilateral right-side ultrasound-guided erector spinae plane block (ESPB) on post-LC pain intensity and opioid consumption. This is a parallel-arm randomized control trial on 62 adult patients with an American Society of Anesthesiologists (ASA) physical status ≤ 2 who underwent LC. The patients were randomized into 2 groups (the block group [BG] and the control group [CG]; n = 31 per group). BG received a single-shot right-sided T7 ESPB with 20 mL of 0.2% ropivacaine at arrival time in the post-anesthesia care unit (PACU). CG) received no regional anesthesia. Both groups received patient-controlled intravenous fentanyl and rescue meperidine for analgesia. The primary outcome was the pain intensity determined using a Numerical Rating Scale (NRS) in the first 24 hours after surgery. Secondary outcomes included total fentanyl and meperidine consumption within 24 hours. Median pain scores were significantly higher in CG at rest and with coughing up to 12 hours after surgery compared with BG. Pain scores were higher in CG with a cough at 24 hours compared with BG (median 1 [interquartile range (IQR) 1, 2] vs. 1 [1, 0]; P = 0.0005). Total fentanyl consumption and meperidine consumption within 24 hours were significantly lower in BG compared with CG (median 60 µg [IQR 60, 90] vs 250 µg [90, 300]; P < 0.0001 and median 20 µg [IQR 10, 20] vs 25 [20, 25]; P = 0.002, respectively). A single-shot, right-sided, unilateral ESPB decreases post-LC opioid consumption and pain.