Background: Knee osteoarthritis (KOA) is a degenerative joint disorder leading to pain and functional impairment. Intra-articular growth factor concentrate (GFC), a refined derivative of platelet-rich plasma, is emerging as a regenerative treatment modality with potential chondroprotective and analgesic effects. Objectives: The objective of this study was to evaluate the efficacy and safety of intra-articular GFC in reducing pain, improving function, and promoting cartilage thickness in patients with moderate KOA living in hilly regions of Uttarakhand. Methodology: A retrospective observational study was conducted at a tertiary care center in Uttarakhand. Fifty patients aged 40–75 years with Kellgren–Lawrence Grade II–III KOA and Numerical Rating Scale (NRS) ≥4 were included. Patients received GFC injections and were assessed at baseline, 3 weeks, 6 weeks, and 3 months. Primary outcome was pain relief (NRS); secondary outcomes included cartilage thickness (ultrasound), WOMAC score, and adverse events. Statistical analysis was performed using repeated measures analysis of variance. Results: The mean NRS scores significantly decreased from 7.2 to 2.5 at 3 months (P = 0.007). Cartilage thickness improved from 2.57 mm to 2.88 mm (P = 0.002). WOMAC score showed significant improvement (23.06% reduction; P < 0.01). Only one patient (1.96%) reported mild local soreness, indicating a favorable safety profile. Conclusions: Intra-articular GFC demonstrated significant pain relief, functional improvement, and increased cartilage thickness over 3 months in moderate KOA patients living in hilly regions of Uttarakhand with minimal adverse effects. These findings support GFC as a viable regenerative therapy in conservative osteoarthritis management. Prospective, long-term studies are warranted.

Background Physical rehabilitation after knee arthroplasty is essential for improving functional outcomes. However, adherence to rehabilitation is poor. We developed a multicomponent mobile application TeleREhabilitation after knee ArThroplasty (TReAT app) comprising education, exercise videos, an e-diary for self-monitoring progress, two-way communication, and remote therapy planning to facilitate home-based rehabilitation. The TReAT trial is a 1:1 randomized controlled superiority trial to evaluate the clinical and cost-effectiveness of the intervention against usual care, with an embedded process evaluation. This paper reports the protocol for process evaluation. Methods and analysis Consenting individuals undergoing knee arthroplasty at a public and private tertiary care hospital in Delhi, who are able to use a smartphone will be randomized to either app-based or usual home-based rehabilitation and followed up at 3 and 6 months to assess knee-related functional outcomes. A mixed-methods convergent parallel design supported by a logic model will be used for a process evaluation. Data from screening log, backend app analytics, interviews with end users, and researcher notes will contribute to the evaluation based on RE-AIM framework. Researcher notes will be quantified and, consolidated with app analytics to summarise fidelity, and adoption. Thematic analysis of interviews will provide insights into contextual factors influencing intervention adoption during the trial and intention to use the TReAT app beyond the trial period. To explore mechanistic pathways correlation between functional outcomes, knowledge score and rehabilitation self-efficacy will be examined. Conclusions The process evaluation will provide insights into the potential uptake and scalability of TReAT intervention. Comparing findings across public and private healthcare settings will enhance understanding of how the intervention functions in different contexts. The findings will inform implementation strategies to improve rehabilitation care using mHealth interventions in India. Trial registration The trial was registered prospectively with the Clinical Trial Registry of India (CTRI/2024/06/068838).

Background Physical rehabilitation after knee arthroplasty is essential for improving functional outcomes. However, adherence to rehabilitation is poor. We developed a multicomponent mobile application TeleREhabilitation after knee ArThroplasty (TReAT app) comprising education, exercise videos, an e-diary for self-monitoring progress, two-way communication, and remote therapy planning to facilitate home-based rehabilitation. The TReAT trial is a 1:1 randomized controlled superiority trial to evaluate the clinical and cost-effectiveness of the intervention against usual care, with an embedded process evaluation. This paper reports the protocol for process evaluation. Methods and analysis Consenting individuals undergoing knee arthroplasty at a public and private tertiary care hospital in Delhi, who are able to use a smartphone will be randomized to either app-based or usual home-based rehabilitation and followed up at 3 and 6 months to assess knee-related functional outcomes. A mixed-methods convergent parallel design supported by a logic model will be used for a process evaluation. Data from screening log, backend app analytics, interviews with end users, and researcher notes will contribute to the evaluation based on RE-AIM framework. Researcher notes will be quantified and, consolidated with app analytics to summarise fidelity, and adoption. Thematic analysis of interviews will provide insights into contextual factors influencing intervention adoption during the trial and intention to use the TReAT app beyond the trial period. To explore mechanistic pathways correlation between functional outcomes, knowledge score and rehabilitation self-efficacy will be examined. Conclusions The process evaluation will provide insights into the potential uptake and scalability of TReAT intervention. Comparing findings across public and private healthcare settings will enhance understanding of how the intervention functions in different contexts. The findings will inform implementation strategies to improve rehabilitation care using mHealth interventions in India. Trial registration The trial was registered prospectively with the Clinical Trial Registry of India (CTRI/2024/06/068838).

Background and Aims: The primary treatment for breast cancer involves surgically removing the affected breast. Different types of anaesthesia used during surgery may have an impact on cancer recurrence. This meta-analysis was conducted to assess the current level of evidence for the impact of the type of anaesthesia for breast cancer surgery on cancer recurrence. Methods: Following PROSPERO registration, a comprehensive database search was conducted across PubMed, Cochrane, Embase, Scopus, and Google Scholar, encompassing all available data up to December 2024. Randomised controlled trials (RCTs) and retrospective studies assessing the effect of inhalational anaesthetic agents on cancer recurrence after breast cancer surgeries were included. The Cochrane Collaboration’s risk of bias and the Newcastle-Ottawa scale were used for risk of bias assessment in RCTs and retrospective studies, respectively. We inverted the hazard ratio (HR) to (1/HR) for studies that reported inhalational as the control group. Results: Eight studies were included: four RCTs and four retrospective cohort studies. No association between the anaesthetic agent used and the recurrence of breast cancer was seen in RCTs (risk ratio (RR) =1.07, 95% confidence interval (CI): 0.89, 1.29). Included retrospective cohort studies showed RR = 1.46 (95% CI: 1.32, 1.62), showing an association of recurrence with inhalational agents compared to total intravenous anaesthesia-based or regional anaesthesia with significant bias. Conclusion: The retrospective studies suggest a possible association between inhalational anaesthesia and breast cancer recurrence. However, these findings should be interpreted with caution due to the inherent limitations of retrospective studies, including a higher risk of bias and variability in control group definitions. This contradicts findings from prospective RCTs. Further research is needed to understand the mechanisms behind this association and to weigh the pros and cons of different anaesthesia techniques.

Neuropathic pain resulting from brachial plexus injuries (BPI) and phantom limb pain (PLP) remains a clinical challenge due to its complex, multifactorial nature involving neuropathic, nociplastic, sympathetic, and myofascial pain mechanisms. This retrospective case series evaluates the efcacy of T2-T3 sympathetic radiofrequency ablation (RFA) as part of a comprehensive multimodal treatment strategy in ve patients with chronic upper limb pain due to BPI, Pancoast tumors, and PLP. Clinical outcomes assessed by visual analog scale (VAS) demonstrated signicant pain relief ranging from 50% to 90% over six months. Interventions targeting myofascial trigger points and sympathetic modulation via T2-T3 RFA provided sustained pain reduction and improved patient outcomes. Incorporating myofascial pain management alongside neuropathic and sympathetic interventions highlights the importance of an integrated treatment approach for complex pain syndromes.

To evaluate the efficacy and safety of duloxetine in treatment of osteoarthritis compared with placebo. We conducted a comprehensive search for pertinent randomized controlled trials (RCTs) across multiple databases, including PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Google scholar. These selected RCTs aimed to assess the effectiveness and safety of duloxetine versus a placebo in the management of osteoarthritis (OA). We computed the mean difference (MD) for continuous outcome measures and calculated the risk ratio (RR) for dichotomous outcome measures. Data from 10 RCT including 2294 participants comparing duloxetine and placebo were pooled. Duloxetine showed improvement in BPI-S (Brief Pain Inventory-Severity)MD = – 0.66; 95

Introduction Monitoring physical rehabilitation is an essential component of patient recovery after knee arthroplasty. Monitoring can be remote, or clinic based. In India, unsupervised home-based physical rehabilitation is a common practice, but there is a lack of evidence to demonstrate the effectiveness of remote monitoring. Therefore, we developed and piloted a mobile application (TeleREhabilitation after knee ArThroplasty app) based on behaviour design thinking to support the recovery period. This trial aims to compare the effectiveness, acceptability, cost and safety of this app-supported home-based intervention against usual care using an open label, 1:1 individual randomised superiority trial at two tertiary care hospitals in India.Methods and analysis Consecutive adults undergoing partial or total, unilateral or bilateral knee arthroplasty who can use a smart phone will be invited to participate in this trial. Consenting individuals will be randomised to either an app-supported intervention or a usual home-based rehabilitation which typically consists of provision of oral or written instructions at discharge and follow-up check-up with the surgeon or physiotherapist at their discretion or as per individual need. We aim to recruit 300 individuals over a period of eighteen months. The primary objective is to compare patient-reported knee function between the two groups at 3 and 6 months postsurgery. Secondary objectives are to compare patient-reported outcomes (pain and activity), performance-based outcomes (lower limb strength and knee function), resource utilisation and quality of life. Fidelity of implementation, end-user experiences and challenges in implementing this intervention will be measured using both quantitative and qualitative methods. Quantitative data will be analysed in Stata, and group comparisons will be done using mixed effect linear regression. A mixed-methods approach will be used to analyse and interpret the process evaluation data. A modified intention-to-treat approach will be taken, which includes all those who were randomised irrespective of their adherence to trial protocol if they had at least one follow-up visit after enrolment.Ethics and dissemination The protocol has been approved by the ethics committees of the sponsor institute (The George Institute for Global Health) and the two clinical sites (All India Institute for Medical Sciences, Delhi & Indraprastha Apollo Hospitals, Delhi). The results will be disseminated via peer-reviewed publications, conference presentations and via plain language newsletters to the trial participants.Trial registration number CTRI/2024/06/068838.

Anterior cervical discectomy is often done for cervical disc diseases. Fusion may be required in cases of myelopathy, radiculopathy, and instability. It carries a significant risk of intraoperative spinal cord injury; thus, major perioperative goals include maintenance of mean arterial pressure for spinal cord perfusion. Postoperatively, early evaluation for complications and pain management is advisable to enhance recovery. Usually, intraoperative goals are achieved by employment of total intravenous anaesthesia, which often requires opioid infusion. Excess use of opioids leads to delayed tracheal extubation, postoperative nausea and vomiting, depressed mental status, etc. This delays postoperative goals and recovery. Non-steroidal anti-inflammatory drugs and cyclo-oxygenase-2 inhibitors used in the early post-surgical period may be associated with increased rates of pseudo-arthrosis, hardware failure, and revision surgery in patients undergoing posterior spinal instrumentation and fusion.[1] To date, there is sparse literature focusing on the erector spinae plane (ESP) block at the cervical level.[2,3] We wish to share our experience of six patients who were given ESP block during single- or dual-level cervical spine surgery. We evaluated the influence of a single-shot bilateral T1 ESP block as an adjuvant to general anaesthesia on perioperative haemodynamic stability, opioid consumption and postoperative recovery in patients undergoing cervical surgery. Consent was obtained from patients for publication of their findings. Patients belonging to the American Society of Anesthesiologists Physical Status I/II had chief complaints of chronic pain with radiculopathy not responding to conservative management. Patients did not have any pre-procedure neurological, sensory, or motor deficits. Using a high-frequency linear ultrasound probe (FUJIFILM SonoSite Edge II Total, Inc., Bothell, WA, United States) in parasagittal orientation, the T1 thoracic transverse process was identified, and a 22-G 80-mm echogenic needle (Stimuplex® Ultra 360® B BRAUN SE, Melsungen AG, Hessen, Germany) was inserted (in-plane approach) to contact the T1 thoracic transverse process. Bupivacaine 0.25%, 15 mL mixed with epinephrine 2.5 μg/mL and dexamethasone 2 mg was administered deep into erector spinae muscle fascia with visible local anaesthetic spread [Figure 1]. The process was done bilaterally. General anaesthesia was induced with intravenous propofol (2 mg/kg), fentanyl (2 μg/kg), and succinylcholine (1 mg/kg) and maintained with dexmedetomidine (0.5 μg/kg/h) and propofol (100 μg/kg/min) intravenous infusions. Postoperatively, additional analgesia was administered only as required, starting with intravenous paracetamol 1 g, followed by intravenous tramadol 50 mg if needed. None of the patients who underwent single-level surgery required rescue analgesics or opioids intraoperatively or postoperatively up to 48 h. However, the three patients who had dual-level surgery needed a single dose of intravenous paracetamol 1 g on 2nd day after 30–36 h, with Numerical Rating Scale 3–4/10. Four patients reported their modified patient satisfaction index (m-PSI) score as 1, while two reported it to be 2 [Table 1]. All patients were discharged as per institutional protocol after 48 h.Figure 1: a: X-ray image of dual level (C5-C6, C6-C7) anterior cervical fusion; b: Ultrasound-guided T1 erector spinae plane block; TP = Transverse ProcessTable 1: Demographics and patient characteristicsESP block provides somatic and visceral analgesia by blocking the dorsal and ventral rami of the spinal nerve. It also blocks autonomic fibres to and from the sympathetic ganglia via rami-communicantes. Due to the extensive cranio-caudal spread of local anaesthetic, it is helpful in blocking larger dermatomes, thus beneficial for dual-level cervical surgeries. Technically, it is simple to perform and safe due to the minimal epidural spread of the drug, allowing for better perioperative haemodynamic control during cervical surgeries. We found that single-shot ESP block leads to reduced opioid usage during anaesthesia and pain-free postoperative hospital stay, even in high BMI patients. This allowed the incorporation of a rehabilitative regimen early without fear, thus ensuring an enhanced recovery. Adjuvant epinephrine slows the entry of local anaesthetic into the plasma and decreases its toxic effect, while dexamethasone prolongs the duration of the block.[4,5] ESP block can be used as an adjuvant for cervical surgeries to ensure reduced use of opioids and analgesics, along with improved pain relief and better patient satisfaction. To validate the efficacy of ESP block for cervical surgeries, rigorous randomised controlled trials are warranted. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the forms, all the patients consented to their images and other clinical information being reported in the journal. The patients understand that their names and initials will not be published, and due efforts will be made to conceal their identities, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

The steep increase in knee arthroplasties in lower- and middle-income countries has increased demand for personalised rehabilitation care. Technology-based rehabilitation programs offer potential to replace or augment conventional face-to-face rehabilitation for providing continuum of care. We aimed to systematically develop a theory, evidence-driven, contextualised, and user-centred mobile health platform for people undergoing knee arthroplasty to facilitate monitoring progress during rehabilitation. We followed the UK Medical Research Council’s framework and adopted a behaviour design thinking approach, consisting of five steps; (1) conduct multiple literature reviews and cross-sectional surveys to determine the needs and problems experienced during the rehabilitation phase by healthcare professionals and individuals with replaced knees, (2) identify target behaviours along with barriers and facilitators, integrated within the Capability, Opportunity, Motivation-Behaviour (COM-B) framework, (3) identify intervention functions and components, behaviour change techniques, and features for the mobile application, selected after discussions with orthopaedic surgeons, physiotherapists and behavioural experts, (4) develop a prototype application for end-users, and a web-based platform for healthcare professionals, and (5) pilot test the intervention for end-users’ feedback on usability of the application and to identify possible strategies for implementing the intervention package. Using the COM-B model, education, training, persuasion, enablement, and modelling were chosen as intervention functions for improving adherence to exercise protocol during early-phase of rehabilitation. The application featured five interlinked components; education, training, goal setting and self-management, communication, and a personalized therapy plan utilising 13 behaviour change techniques. An education booklet, exercise videos, text messaging, video consultation, and a digital tool for measuring range of motion were incorporated into the application. Feedback on the interactive prototype and education material was sought from ten patient volunteers and a physiotherapist. Pilot testing in a convenient sample with broad eligibility criteria (n = 30) indicated importance of digital literacy and dedicated time for remote consultation by healthcare provider within the existing clinical work. Overall, the intervention was well received and valued by the end users. This paper demonstrates the development of a contextualised digital behavioural intervention grounded in behavioural theory and evidence from literature to improve end-user’s engagement with rehabilitation protocols after knee arthroplasty in lower- and middle-income country context. Study registered prospectively (on 16 February 2023) at Clinical Trials Registry of India (CTRI/2023/02/049792).

Introduction: Smartphone applications using in-built gyroscope chips are attractive options that can facilitate self-assessment of knee range of motion without having to wear a sensor-based device. Methods: A cross-sectional study was conducted to compare this smartphone-based app with universal goniometer (UG) in assessing active knee range of motion in sitting and lying position. Consecutive patients with knee osteoarthritis or those who had knee replacement or the healthy accompanier and hospital staff above 18 years of age and consenting to volunteer were approached for the study at a tertiary care academic hospital in India. The comparisons were repeated measurements with UG and test-app under same conditions, UG versus test-app, physiotherapist versus patient’s accompanier with test-app in the same phone, in different phones, and a physiotherapist measuring on different stool heights using test-app. We report mean difference between two measurements with 95% limits of agreement and intraclass correlation coefficient (ICC) calculated using one-way random effects. Result: The 95% LoA between the UG and test-app in supine flexion was -7.5° to +4.5° and extension was ±4°. The test retest 95% LoA of the test-app in supine flexion and sitting flexion across all scenarios was within ± 8.5°. The test-retest 95% limits of agreement of extension in sitting and supine position across all scenarios was within ±6.5°. Test-retest reliability (ICC) of knee flexion ranged between 0.70 to 0.99 and extension between 0.16 to 0.97 across all scenarios. Conclusion: The smartphone-based app is reliable to differentiate between various ranges of motion of knee with measurement errors no greater than universal goniometer. This app has the potential to measure changes in ROM that are above 8° of flexion and above 7° in extension.This app can enhance the ability to remotely measure and monitor knee ROM of pathologic knee.

Background and Aims:Short-term hypotension after general anaesthesia can negatively impact surgical outcomes. This study compared the predictive potential of the pleth variability index (PVI), pulse pressure variability (PPV), and perfusion index (PI) for anaesthesia-induced hypotension. This study's primary objective was to evaluate the predictive potential of PI, PVI, and PPV for hypotension. Methods:This observational study included 140 adult patients undergoing major abdominal surgery under general anaesthesia. Mean arterial pressure, heart rate, PVI, PPV, and PI were collected at 1-min intervals up to 20 min post anaesthesia induction. Hypotension was assessed at 5-min and 15-min intervals. Receiver operating characteristic (ROC) curves were plotted to determine the diagnostic performance and best cut-off for continuous variables in predicting a dichotomous outcome. Statistical significance was kept at P < 0.05. Results:Hypotension prevalence within 5 and 15 min of anaesthesia induction was 36.4% and 45%, respectively. A PI cut-off of <3.5 had an area under the ROC curve (AUROC) of 0.647 (P = 0.004) for a 5-min hypotension prediction. The PVI's AUROC was 0.717 (P = 0.001) at cut-off >11.5, while PPV's AUROC was 0.742 (P = 0.001) at cut-off >12.5. At 15 min, PVI's AUROC was 0.615 (95% confidence interval 0.521-0.708, P = 0.020), with 54.9% positive predictive value and 65.2% negative predictive value. Conclusion:PVI, PPV, and PI predicted hypotension within 5 min after general anaesthesia induction. PVI had comparatively higher accuracy, sensitivity, specificity, and positive predictive value than PI and PPV when predicting hypotension at 15 min.

A 55-year-old woman with adenocarcinoma rectum and adnexal mass with suspected peritoneal/omental deposits was scheduled for diagnostic laparoscopy to rule out peritoneal metastasis, stage the cancer and decide further management. Shortly after tracheal intubation with the rapid sequence technique, the patient’s saturation level dropped to 88%. This case highlights the importance of ventilatory strategies along with surgical intervention for management and uneventful outcomes.

BackgroundSuccessful post-knee replacement rehabilitation requires adequate access to health information, social support, and periodic monitoring by a health professional. Mobile health (mHealth) and computer-based technologies are used for rehabilitation and remote monitoring. The extent of technology use and its function in post-knee replacement rehabilitation care in low and middle-income settings are unknown. ObjectiveTo inform future mHealth intervention development, we conducted a scoping review to map the features and functionality of existing technologies and determine users’ perspectives on telerehabilitation and technology for self-management. MethodsWe followed the Joanna Briggs Institute methodology for scoping reviews. We searched the Embase, Medline, PsycINFO via OVID, and Cochrane Central Register of Controlled Trials databases for manuscripts published from 2001 onward. We included original research articles reporting the use of mobile or computer-based technologies by patients, health care providers, researchers, or family members. Studies were divided into the following 3 categories based on the purpose: validation studies, clinical evaluation, and end user feedback. We extracted general information on study design, technology features, proposed function, and perspectives of health care providers and patients. The protocol for this review is accessible in the Open Science Framework. ResultsOf the 5960 articles, 158 that reported from high-income settings contributed to the qualitative summary (64 studies on mHealth or telerehabilitation programs, 28 validation studies, 38 studies describing users’ perceptions). The highest numbers of studies were from Europe or the United Kingdom and North America regarding the use of a mobile app with or without wearables and reported mainly in the last decade. No studies were from low and middle-income settings. The primary functions of technology for remote rehabilitation were education to aid recovery and enable regular, appropriate exercises; monitoring progress of pain (n=19), activity (n=20), and exercise adherence (n=30); 1 or 2-way communication with health care professionals to facilitate the continuum of care (n=51); and goal setting (n=23). Assessment of range of motion (n=16) and gait analysis (n=10) were the commonly validated technologies developed to incorporate into a future rehabilitation program. Few studies (n=14) reported end user involvement during the development stage. We summarized the reasons for satisfaction and dissatisfaction among users across various technologies. ConclusionsSeveral existing mobile and computer-based technologies facilitate post-knee replacement rehabilitation care for patients and health care providers. However, they are limited to high-income settings and may not be extrapolated to low-income settings. A systematic needs assessment of patients undergoing knee replacement and health care providers involved in rehabilitation, involving end users at all stages of development and evaluation, with clear reporting of the development and clinical evaluation can make post-knee replacement rehabilitation care in resource-poor settings accessible and cost-effective.

Patients with head and neck cancer (HNC) have ongoing pain but Stellate ganglion block which is a sympatholytic block may be a viable therapy for treating it. The data were retrospectively collected from five histopathologically confirmed HNC patients who had completed chemotherapy and radiation doses. Stellate ganglion block was given to these patients and was subsequently monitored for 3 months to assess pain alleviation and overall satisfaction. Over a 3-month period, there was a decrease in the pain levels with a better quality of life so the stellate ganglion block can be a promising modality for reducing the pain of HNC.

Department of Anaesthesiology, Critical Care and Pain, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India Address for correspondence: Dr. Ajit Kumar, Associate Professor, Department of Anaesthesiology, Critical Care and Pain, All India Institute of Medical Sciences, Rishikesh - 249203, Uttarakhand, India. E-mail: [email protected] Received September 03, 2021 Received in revised form December 17, 2021 Accepted December 21, 2021 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 4.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Brachial plexus injury (BPI) occurs commonly in young adults following trauma. This may result in the development of complex regional pain syndrome (CRPS) following injury, which is difficult to treat. We present a group of patients with CRPS secondary to BPI. These patients were managed with neuromodulation of the stellate ganglion (SG) with pulsed radiofrequency (PRF) and followed up for a period of 3 months to assess for pain relief and a decrease in the intake of medications after the intervention. PRF to SG was found to have significant pain relief lasting around three months.

Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes Background and Aims Low back pain due to lumbar radiculopathy is the cause of significant disability. Epidural steroid injections with or without local anaesthetic are often prescribed to patients who are not responding to conservative management. Epidural injections may carry the attended risk of neurological injuries. We hypothesized that the nociceptor fibres being pseudo – unipolar in nature, with both ends behaving functionally the same. The peripheral nerve blocks administered distally should be as effective in providing pain relief. Methods The thirty-four patients who had been recruited in the single-arm study were followed up at 6 months and 12 months post the intervention and the outcomes were noted. They had been administered peripheral nerve blocks at ankle level with 4ml of 0.25% bupivacaine and 40mg of triamcinolone. Outcomes measured: The outcomes measured at 6 and 12 months after the intervention were the pain intensity (Numerical Rating Scale), the Global Perceived Effect, employment status, and analgesic intake. Results Out of 34 patients, 4 had dropped out at 6 months and 12 at 12 months. Statistical analysis of the data showed a significant decrease in pain intensity (p<0.001). There was also a significant improvement in both the employment status and the analgesic intake and no additional side effects were reported by any of the patients. Conclusions This present study shows that peripheral nerve blocks are effective in the management of pain in patients with lumbosacral radiculopathy even in the long term (1 year) with no significant adverse effects. Attachment 72429883_d5d6_4353_814d_1ebc4cb72bdf.pdf

Background and Aims: Prolapsed intervertebral disc (IVDP) is a major cause of low back pain. Platelet-rich plasma (PRP) has emerged as a viable option for these patients, with fewer adverse effects and long-term sustainability of pain relief. This double-blinded, randomised study aimed to evaluate the effect of autologous PRP on low back pain in patients with IVDP. Methods: A total of 42 patients with IVDP were randomised either to the autologous PRP (n = 21) group or control (epidural local anaesthetics with steroids; n = 21) group. Change in pain was assessed using the Numeric Rating Scale (NRS). Impact of treatment was assessed using the Global Perceived Effect (GPE) scale. All the patients were followed up for six months. Data was compared using Chi-square, independent sample t, and Mann–Whitney U tests. Results: The two groups were similar in their demographic and clinical profile. The baseline mean NRS ± standard deviation (SD) was 6.91 ± 0.94 in the PRP group and 7.38 ± 1.16 in the control group (P = 0.099). At six months, the mean NRS ± SD was 1.43 ± 0.75 in the PRP group compared to 5.43 ± 0.75 in the control group (P < 0.001). The GPE score was also found to be significantly higher in the PRP group, compared to the control group in the final assessment (P < 0.001). During the course of the study, the PRP group showed a consistent decline in NRS, whereas the control group showed an initial decline followed by consistent increase in NRS. Conclusion: PRP provided sustained relief from low back pain due to IVDP and can be recommended as a safe and promising alternative to epidural local anaesthetics and steroids.