Background: Platelet-rich plasma (PRP) has proved to be beneficial due to its remodeling property in various conditions in the past. When given intra-articularly, it may also provide adequate analgesia in low back pain. Aims: This study was aimed to compare the efficacy between intra-articular sacroiliac joint (SIJ) injection of PRP and steroid in the management of SIJ dysfunction pain. Materials and Methods: This prospective, randomized parallel group study was conducted for 24 months period at a tertiary care hospital. A total of 50 patients above 18 years were included in the study and allocated into two groups ( n = 25) by computer randomization. Patients in the respective group received sacroiliac intra-articular injection of either autologous PRP or triamcinolone (steroid). For the primary outcome, the Numerical Rating Scale Score was recorded preprocedure and postprocedure at the 24 h, 1 st , 3 rd , and 6 th month. The need for any rescue analgesia or repeat injection during the study period was considered the secondary outcome. Results: At the 1 st , 3 rd , and 6 th month postprocedure, 100%, 88%, and 76% of patients, respectively, obtained significant pain relief after injection of PRP. In contrast, at 3 rd and 6 th month postprocedure, only 20% and 28%, respectively, had short-term pain relief in the steroid group. Conclusions: Single intra-articular injection of PRP provides significant pain relief and functional improvement in patients with SIJ pain.

The difficult airway is already a challenging situation for anesthesiologists, in that scenario Succinylcholine (SCh) use, because of its rapid onset and short duration of action makes it a neuromuscular blockage drug of choice. Development of masseter muscular rigidity is thought to be an early indicator of the occurrence of the dreaded consequence, malignant hyperthermia. Consequently, it is essential to understand the potential side effects of this widely used drug in order to successfully treat the airway. Resulting is the use of videolaryngoscopic intubation along with propofol use and the procedure was completed successfully with no intraoperative or postoperative problems. Here, we described a case report of a 33-year-old male patient with a difficult airway posted for open reduction internal fixation of bilateral Lefort’s III fracture, developed masseter muscle rigidity (MMR) following administration of a standard dose of SCh.

The Indian Society of Anaesthesiologists (ISA) brought together all the experienced as well as the young and aspiring anaesthesiologists from across the globe to experience the tornado of academic events held in the pristine hill station of Meghalaya-Abode of the Clouds. The Platinum Jubilee Year of ISA celebrated its 69th annual conference at North Eastern Indira Gandhi Regional Institute of Health and Medical Science (NEIGRIHMS), Shillong with its serene beauty showcased the latest advancements in the field of anaesthesiology but also highlighted the importance of collaboration and innovation in healthcare from November 24th to November 27th 2022. The themes of ISACON 2022 “Safe Anaesthesia Practices-Accessible To All” emphasized the need for a safe anaesthesia approach to reach inaccessible areas, focusing on not only the technical aspects of patient management but also the emotional and psychological well-being. Delegates had the opportunity to present their research findings and innovative ideas through paper and poster presentations. The abstracts for these covered various aspects of anaesthesiology, critical care and pain medicine. To conclude I would like to thank the entire ISACON 2022 organising team headed by Dr. Prithwis Bhattacharrya (Chairman), Dr. Nari M Lyngdoh (Organising Secretary), Dr. Diganta Das (Chief organising Secretary), as well as the ISA Meghalaya team for their immense hard work in making ISACON 2022 a successful academic year event. I extend my gratitude to Dr. Venkatagiri K.M (President, ISA National), Dr. Anjali Bhure (Vice President, ISA National), Dr. Naveen Malhotra (Honorary Secretary, ISA National), Dr. Muralidhar Joshi (Chairman Academic Committee, ISA National) and all the members of ISA National Headquarters for their guidance in each and every step in this event. Shillong’s natural beauty provided a serene backdrop for this intellectual exchange of knowledge, making ISACON 2022 a memorable and impactful event that will leave an enduring impression.

During reconstructive interventions in patients presenting with severe post-burn mento-sternal scar contracture, securing the airway forms a critical part of management. Extreme contracture is more likely to develop in patients who have had thoracic burns with ascending involvement of the neck and mandibular region. When cervical hyperextension and elevation of the mandible are impeded, post-burn contracture of the neck might render endotracheal intubation difficult. The development of rigid scar tissue that distorts the laryngeal and mandibular anatomy, or the development of microstomia following scar tissue retraction in facial burns, may make alternative approaches to direct laryngoscopy challenging. In patients with healed neck burns, intubation difficulties should be anticipated, and equipment for aiding intubation should be kept ready. Furthermore, a surgeon must be present throughout anesthesia induction in case an emergency neck release is required. Although the role of awake fiberoptic intubation has been well established in the general population, it is yet to be assessed in patients with burns. In this report, we present a case of successfully managed post-burn contracture that was planned for awake fiberoptic intubation.

Background and aims:For the prevention of PONV, we evaluated the efficacy of palonosetron compared with ondansetron along with dexamethasone in patients undergoing laparoscopic gynaecological surgery. Methods:A total of 84 adults, posted for elective laparoscopic surgeries under general anaesthesia were included in the study. The patients were randomly allocated to two groups (n = 42 each). Immediately after induction, patients in the first group (group I) received 4 mg ondansetron with 8 mg dexamethasone, and patients in the second group (group II) received 0.075 mg palonosetron. Any incidences of nausea and/or vomiting, the requirement of rescue antiemetic, and side effects were recorded. Results:In group I, 66.67% of the patients had an Apfel score of 2, and 33.33% of the patients had a score of 3. In group II, 85.71% of patients had an Apfel score of 2, and 14.29% of the patients had a score of 3. At 1, 4, and 8 hours, the incidence of PONV was comparable in both groups. At 24 hours there was a significant difference in the incidence of PONV in the group treated with ondansetron with dexamethasone combination (4/42) when compared to the palonosetron group (0/42). The overall incidence of PONV was significantly higher in group I (23.81%: ondansetron and dexamethasone combination) than in group II (7.14%: palonosetron). The need for rescue medication in group I was significantly high. Conclusion: Palonosetron was more efficacious compared to the combination of ondansetron and dexamethasone for preventing PONV for laparoscopic gynaecological surgery.

Hematological parameters like total leukocyte count (TLC), neutrophil, lymphocyte, and absolute eosinophil counts (AEC), and neutrophil-to-lymphocyte ratio (NLR) are known to predict the severity of novel coronavirus disease 2019 (COVID-19) patients. In the present study, we aimed to study the role of complete blood count parameters in triaging these patients requiring intensive care unit (ICU) admission. A retrospective study was done over a period of 2 months. Patients, who were ≥ 18 years of age with COVID-19 confirmed on SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) and whose routine hematology counts were sent within 24 h of admission, were included in the study. Cut-off values of 47.5 years for age, 11.3 × 109/L for TLC, and 9.1 for NLR were predictive of disease severity among COVID-19 patients. Relative neutrophilia ≥ 70% (p < 0.007), relative lymphopenia ≤ 20% (p < 0.002), AEC ≤ 40/cumm (p < 0.001), and NLR ≥ 9.1 (p < 0.001) were significantly associated with ICU admission. Routine hematological parameters are cost-effective and fast predictive markers for severe COVID-19 patients, especially in resource-constrained health care settings to utilize limited ICU resources more effectively.

Introduction: Various types of arrhythmia have been reported during cesarean section under spinal anesthesia. But the possible causative factors and the effects of arrhythmia on immediate post-delivery neonatal outcome are not well established. Methods: This prospective observational study was conducted over a period of one year in a tertiary care hospital on women undergoing cesarean section under spinal anesthesia. The objectives of the study were to determine the incidence of arrhythmia, its types, the possible factors influencing arrhythmia, and the immediate post-delivery neonatal outcome. Data collected were analyzed using Statistical Package for the Social Sciences (SPSS) software version 21 (IBM Corp. Armonk, NY). Results: In our study, the incidence of arrhythmia was 31.9% during cesarean section under spinal anesthesia; and sinus bradycardia was the most common type. Arrhythmia occurred more in women with hypotension, when maximum block height was above T4 level and dose of intrathecal hyperbaric bupivacaine was more than 2.2 mL (P value <0.05). Also, uterine manipulation led to sudden bradycardia and transient cardiac asystole in two patients which was preceded by subjective symptoms of pain and discomfort. None of the neonates required cardiopulmonary resuscitation or neonatal intensive care unit admission within an hour of birth. APGAR (Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration) scores at 1 and 5 minutes were similar in all the newborns born to mothers with or without arrhythmia. Conclusion: The occurrence of arrhythmia during cesarean section under spinal anesthesia, though very common, is rarely life-threatening. Keeping maximum level of block height between T4 and T6, using lower possible drug dose to provide adequate level of sensory block, prompt management of hypotension, and strict monitoring during uterine manipulation may reduce the overall incidence of arrhythmia. Intraoperative arrhythmia, however, does not adversely affect the immediate post-delivery neonatal outcome.

Background: The ongoing COVID-19 pandemic has affected the current health care to the core. As a result, there is a shift of focus on health care to control the pandemic. The chronic pain patients, though at risk, are also the sufferers. The aim of this online survey was to evaluate the perspective of the pain physicians on chronic pain management during COVID-19 pandemic in India. Methods: The survey was conducted under the aegis of Indian society for study of pain. The questionnaire in the form of Google Forms was filled by pain physicians online after webinar. Results: In this survey, majority of the pain physicians (71.12%) reported that they are practicing pain even during COVID pandemic but with precautions. Around 65.77% of the pain physicians were using telemedicine for consultation. A prior COVID test for interventional procedures was opted by 85.56% of pain physicians. Total 89.30% feel that personal protective equipment is necessary for doing pain interventions. Meanwhile, during the pandemic, 97.32% of the pain physicians are attending webinars to keep themselves updated. Conclusion: This survey of pain physicians' perspectives on impact of COVID-19 shows that chronic pain practice was greatly affected. Although webinars are a modality to keep the pain physicians updated, telemedicine has taken its stride forward to prove its major role during this pandemic for consultation. The personal protection is the new must-have among pain physicians in clinics and hospitals during and after pandemic.

Posterior reversible encephalopathy syndrome (PRES) usually presents with headache, confusion, visual disturbances or blindness and seizures. MRI is gold standard with parieto-occipital white matter changes due to vasogenic oedema in most of the cases. We report a 20-year-old unbooked primigravida with eclampsia prior to delivery which got complicated by PRES after delivery on day 1 postpartum. General anesthesia was given for caesarean section and post operatively patient was managed in ICU with strict blood pressure and seizure control. Clinical improvement with complete resolution without any complications was observed on the day 10 postpartum.

Objective: To evaluate the safety and efficacy of dexmedetomidine versus propofol as a sedative modality for awake fiber-optic intubation (AFOI) in elective patients with anticipated difficult intubation. Materials and Methods: This randomized prospective study was conducted on 90 patients (Group D and Group P; n = 45) who had undergone AFOI for anticipated difficult airway. Group D received intravenous (IV) dexrnedetomidine and Group P patients received IV propofol, until they were adequately sedated. Sedation was measured by Bispectral index(C) and Ramsay Sedation Scale. Airway blocks were given to all patients undergoing awake fiber-optic intubation. Intubation comfort scores, airway obstruction scores, and hemodynamics were recorded in all patients. Results: Sedation level was comparable in both the groups. Intubation time was less in Group D than Group P (119.06 +/- 16.51 s vs. 126.67 +/- 18.19 s; P < 0.05). The intubation score for both cough and vocal cord opening was better in the dexmedetomidine group than the propofol group (P = 0.6). There were significant incidences of airway obstruction and hypoxia in Group P compared to Group D (P < 0.05). Significant fall in mean arterial pressure (MAP) was seen in Group P during drug infusion which continued till fiber-optic bronchoscopy (P < 0.05). MAP changes during intubation were similar during intubation in both the groups (P = 0.18). Conclusion: Dexmedetomidine is a better alternative for achieving optimal sedation during AFOI.

BACKGROUND AND AIM:Nalbuphine as an adjuvant intrathecally can produce significant analgesia with minimal side effects. However, no research has been done with isobaric ropivacaine. We, therefore, in this prospective, randomised double-blind study tried to find the optimal dose of intrathecal nalbuphine with isobaric 0.75% ropivacaine for elective lower limb surgeries. MATERIALS AND METHODS:One hundred American Society of Anaesthesiologists I and II patients undergoing elective lower limb surgery were divided into four groups randomly: groups A, B, C and D, who received 0.5 mL normal saline or 0.4, 0.8 and 1.6 mg nalbuphine made up to 0.5 mL normal saline added to 22.5 mg (total volume 3.5 mL) isobaric 0.75% ropivacaine, respectively. The onset of sensory and motor block, two-segment regression time, duration of sensory and motor block, Visual Analogue Scale (VAS) and the incidence of adverse effects were compared between the groups. RESULTS:The onset of both sensory and motor blockade was faster with addition of 0.4, 0.8 and 1.6 mg of nalbuphine when compared with ropivacaine alone; however, it was not statistically significant (P > 0.05). Two-segment regression time and duration of analgesia and motor blockade were highest with 1.6 mg of nalbuphine followed by 0.8, 0.4 and plain 0.75% ropivacaine (P < 0.05). The duration of sensory blockade in all four groups was slightly more than the duration of motor blockade. VAS readings were comparable in all nalbuphine groups when compared with ropivacaine group. Haemodynamic variability among the four groups was comparable. Incidence of adverse effects was highest in the 1.6-mg group when compared with others, although it was statistically insignificant (P > 0.05). CONCLUSION:Nalbuphine can be a good alternative to other opioids as an adjuvant intrathecally to prolong postoperative analgesia with a minimal side effect profile. Addition of nalbuphine to isobaric 0.75% ropivacaine gives the added advantage of significant analgesia with early motor recovery. We infer from our study that when compared with 1.6 mg of nalbuphine, both 0.4 and 0.8 mg nalbuphine are equally good as adjuvants to isobaric 0.75% ropivacaine in elective lower limb surgeries with prolonged analgesia, a reliable block with equal efficacy but with lesser side effects.

Background: Sacroiliac joint dysfunctional pain has always been an enigma to the pain physician, whether it be the diagnosis or the treatment. Diagnostic blocks are the gold standard way to diagnose this condition. Radiofrequency neurotomy of the nerves supplying the sacroiliac joint has shown equivocal results due to anatomical variation. Intraarticular depo-steroid injection is a traditional approach to treating sacroiliac joint pain. For long-term pain relief, however, lesioning the sacral lateral branches may be a better approach. Objective: This study compared the efficacy of intraarticular depo-methylprednisolone injection to that of pulsed radiofrequency ablation for sacroiliac joint pain. Study Design: This study used a randomized, prospective design. Setting: Thirty patients with diagnostic block-confirmed sacroiliac joint dysfunctional pain were randomly assigned to 2 groups. One group received intraarticular methylprednisolone and another group underwent pulsed radiofrequency of the L4 medial branch, the L5 dorsal rami, and the lateral sacral branches. Results: Reduction in Numeric Rating Scale (NRS) for pain at 1 month post-procedure remained similar in Group A, while in Group B few patients reported a further decrease in the NRS score (3.333 ± 0.4880 and 2.933 ± 0.5936, respectively). At 3 months post-procedure, the NRS score began to rise in most patients in group A, while in Group B, the NRS score remained the same since the last visit (4.400 ± 0.9856 and 3.067 ± 0.8837, respectively). At 6 months post-procedure, the NRS score began to rise further in most patients in group A. In Group B, the NRS score remained the same in most of the patients since the last visit (5.400 ± 1.549 and 3.200 ± 1.207). There was a marked difference between the 2 groups in Oswestry Disability Index (ODI) scores at 3 months post-procedure (Group A, 12.133 ± 4.486 vs Group B, 9.133 ± 3.523) and at 6 months post-procedure there was a significant (P = 0.0017) difference in ODI scores between Group A and Group B (13.067 ± 4.284 and 8.000 ± 3.703, respectively). Global Perceived Effect (GPE) was assessed in both groups at 3 months post-procedure Only 33.3% (Confidence Interval (CI) of 11.8- 61.6 ) of patients in Group A had positive GPE responses whereas in Group B, 86.67% (CI of 59.5- 98.3 ) of patients had positive GPE responses. At 6 months post-procedure, the proportion of patients with positive GPE declined further in Group A, while in Group B, positive GPE responses remained the same (20% with a CI of 4.30- 48.10 and 86.67% with a CI of 59.5- 98.3, respectively ). Limitations: Small sample size. Conclusion: This comparative study shows that pulsed radiofrequency denervation of the L4 and L5 primary dorsal rami and S1-3 lateral branches provide significant pain relief and functional improvement in patients with sacroiliac joint pain. Key words: Low back pain, sacroiliac joint dysfunctional pain, radiofrequency, intraarticular injection