Browsing by Author "Anil K. Paswan"

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A Randomized Controlled Trial Comparing the Effect of Two-Time Durations of Balloon Compression During Percutaneous Balloon Compression in Resistant Trigeminal Neuralgia
(American Society of Interventional Pain Physicians, 2024) M. Madivanan; Nimisha Verma; Anil K. Paswan; Shashi Prakash; Arvind Bhaleka
Background: Percutaneous balloon compression of the trigeminal nerve’s gasserian ganglion for the treatment of trigeminal neuralgia is an interventional pain procedure with results comparable to microvascular decompression surgery. The procedure is safe in experienced hands and has less morbidity associated with it. However, there is a lack of clear-cut guidelines about the details of the technique like balloon shape, inflation pressure, and duration of inflation. So, keeping the inflation pressure and shape of the balloon constant, we studied the effect of the duration of inflation of the balloon and its effect on pain relief in refractory trigeminal neuralgia cases. Objectives: To study the outcome with 2 different durations of balloon inflation times in terms of pain relief and complications after percutaneous balloon compression. Study Design: Prospective parallel design randomized, controlled trial. Setting: The study was conducted in a tertiary care hospital in North Eastern India after obtaining approval from the Institutes’ ethics committee (Dean/2018/EC/449). The study was also registered with the Clinical Trials Registry of India (CTRI no. CTRI/2019/03/018166). All patients referred to a pain clinic for unilateral facial pain were screened for the study over 2 years from April 2019 to March 2021. Methods: Forty patients who met the diagnosis of trigeminal neuralgia and who did not respond satisfactorily to medications were included in the study. They underwent routine blood investigations and a magnetic resonance image of the brain to rule out any medical or surgical conditions. Percutaneous balloon compression was conducted under C-arm guidance using a 12 gauge cannula and a 4 Fr Fogarty balloon was used for compressing the gasserian rootlets. Results: Patients who underwent 90 seconds as well as 120 seconds showed good pain relief. The 2 groups did not show any significant difference in pain relief based on the duration of compression. Visual analog scale scores were reduced from 7-8 to 0-3. Masseter muscle weakness was present in 47.5% of patients post-procedure and recovered in all except one patient. Limitations: We have followed up with our patients for a short period of 6 months only. We could not measure the intra-luminal compression pressure of the balloon. Conclusion: There is no difference in the pain relief obtained by the 2 different durations of compressions. A longer duration of compression, however, has more incidence of side effects. © 2024, American Society of Interventional Pain Physicians. All rights reserved.
Automated percutaneous lumbar discectomy in > patients suffering from prolapsed intervertebral disc: A prospective study
(Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2016) Anil K. Paswan; Shalini Gupta; Shashi Prakash; Rajeev K. Dubey; Sandcep Khuba; Virendra Rastogi
Background: A variety of minimally invasive techniques (chemonucleolysis, laser, automated' percutaneous discectomy, percutaneous manual nucleotomy) have been invented over the year as treatment of low hack pain related to disc disease. Automated percutaneous lumbar dissectomy (APLD)| being one of these techniques, is a modality in which removal of nucleus pulposus, reduces intradiscal. pressure thus relieves the nerve root compression and subsequently reduces radicular pain. This technique was introduced by Onik in 1985, referred to as 'automated' since it involves, a mechanical, probe, working by a 'suction and cutting action for removal of the nucleus pulposus. Methodology: After meeting the inclusion criteria, minimal invasive procedure APLD, pdrformed'in /no between 2012 to 2015 on 120 patients on outdoor basis. Radicular discogenic pain was confirmed by,MR1 and clinical finding, procedure is being performed using nucleotome under fluoroscopic guidance. Result: Based on patient satisfaction, 72 (60%) patients had excellent pain relief,{75. -100%), 3.4(28.3%) had good pain relief (51-74%) whereas 14 (11.7%) patients had poor pain, relief Two (1.6%)patient developed discitis, which was the only complication and it resolved within fifteen days without sequelae. Conclusion: Percutaneous decompression (APLD) techniques for intervertebral dis hernition are safe and cost-effective techniques with significant and long lasting results concerning pain reduction.and. mobility improvement. They can be proposed as initial treatment or attractive prior to major surgery..
Sedation with propofol during combined spinal epidural anesthesia: Comparison of dose requirement of propofol with and without BIS monitoring
(2013) R.K. Verma; Anil K. Paswan; Shashi Prakash; Surender K. Gupta; P.K. Gupta
Background: Bispectral (BIS) monitoring provides an objective, non-invasive measure of the level of consciousness in sedated patients. Sedation has been shown to increase patient satisfaction during regional anesthesia. Propofol is extensively being used as a sedative, providing sedation while patients remain cooperative and can be easily aroused. In this study, we sought to determine whether BIS is a useful adjunctive manoeuvre to reduce the sedative dose of propofol by using BIS. Methodology: Forty patients of ASA grade I and II, weighing between 30 to 60 kg, undergoing elective gynecological surgery of about 60 minutes duration were included in the study, and randomly divided into two groups. All patients received combined spinal epidural anesthesia (CSEA). The patients in Group-P (n=20) received propofol without BIS monitoring and those in Group-PB (n=20), received propofol under BIS monitoring. Total doses of propofol consumed in all patients were calculated and compared using paired t-test. A p-value <0.05 was considered to be significant. Results: The mean total dose of propofol consumed was 130.25 mg ± 46.95 without BIS monitoring (Group-P) compared to 68.49 mg ± 12.59 in patients (Group-PB) in which BIS was used to monitor the desired sedation level (P< 0.001). Mean dose to reach required level of sedation was also reduced (68.35 ± 21.10 vs 29.01 ± 9.45, P< 0.001). Conclusion: Use of BIS during propofol infusion reduces requirement of propofol for sedation during regional anesthesia.