Browsing by Author "Rajeev Kumar Dubey"

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Comparative Evaluation Of Efficacy Of Percutaneous Intradiscal Radiofrequency Ablation And Platelet Rich Plasma Injection For Discogenic Low Back Pain: A Prospective Randomized Trial
(World Scientific, 2022) Titiksha Goyal; Anil Kumar Paswan; Dhruv Jain; Nimisha Verma; Rajeev Kumar Dubey
Background: Discogenic pain is a common, yet underdiagnosed cause of low backache, for which a wide array of radiofrequency (RF) ablative techniques and regenerative therapies have been tried with variable results. The objective of the study was to compare pain relief and improvement in function between percutaneous intradiscal RF ablation and platelet-rich plasma (PRP) injection for the treatment of discogenic low backache. Methods: This double-blind, randomized, parallel-group interventional study was carried out in patients with chronic lumbar discogenic pain. Twenty-four patients each in percutaneous intradiscal radiofrequency (PIRF) ablation (Group R) and PRP injection (Group P) groups were analyzed. Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) were calculated before the procedure, and at 3 and 6 months after the procedure. Results: At 3 months, NRS score was significantly less in group R compared to group P (P=0.001). However at 6 months, there was no statistically significant difference between NRS and ODI of both groups (P=0.616 and 0.369, respectively). Both NRS and ODI decreased significantly over 6 months within each group. Conclusion: No significant difference in efficacy of PIRF ablation and intradiscal PRP injection was observed at 6 months follow-up, although there was a significant improvement in pain and disability with both the procedures. © 2022 World Scientific Publishing Company.
Intradiscal platelet-rich plasma injection for discogenic low back pain and correlation with platelet concentration: A prospective clinical trial
(Oxford University Press, 2020) Dhruv Jain; Titiksha Goyal; Nimisha Verma; Anil Kumar Paswan; Rajeev Kumar Dubey
Objective. Discogenic pain is common cause of low back ache and may result in significant morbidity. Platelet-rich plasma (PRP) is an upcoming regenerative therapy that has treatment potential for this condition. The objective of this study was to correlate platelet concentration in intradiscal PRP injection with improvement in low back pain and functional status at three and six months. Design. Prospective single-arm interventional study. Setting. Outpatient pain clinic and operation theater. Subjects. Twenty-five patients with discogenic pain diagnosed by clinical means and imaging with confirmation by provocative discography were recruited. Methods. The patients received PRP injection at a single or multiple disc levels. Preprocedure numerical rating scale (NRS) pain scores and Oswestry Disability Index (ODI) scores were calculated. Platelet counts of patients and PRP samples were measured. At three and six months postprocedure, NRS and ODI scores were measured, and improvement in these scores was correlated with platelet concentrations in the PRP sample. Results. Twenty patients completed the study. The improvement in NRS and ODI scores positively correlated with platelet concentrations in the PRP sample. We determined the correlation coefficient (r) of platelet concentrations with a reduction in NRS at three months (r=0.65) and six months (r=0.73) and in ODI score at three months (r=0.72) and six months (r=0.7). Conclusions. This study supports the use of intradiscal PRP for treatment of discogenic pain with preferably higher platelet counts to elicit a favorable response. © 2020 Oxford University Press. All rights reserved.
Propofol requirement during propofol and butorphanol anesthesia with and without nitrous oxide in short duration intracranial surgeries: A bispectral index guided study
(2012) Surya Kumar Dube; Rajeev Kumar Dubey; Lal Dhar Mishra
Introduction: Propofol is a preferred agent in neurosurgical anesthesia because of its favorable effects on cerebral hemodynamics and excellent recovery profile. Butorphanol is a synthetic opioid which is 5-8 times more potent than morphine and is known to provide stable hemodynamics during various surgical procedures. Owing to its unfavorable effects on cerebral metabolism and hemodynamics nitrous oxide has a debatable role in neurosurgical anesthesia. But studies on exact dose requirement during propofol induction and maintenance anesthesia along with butorphanol with and without the use of N2O during craniotomies are lacking. So we aimed at studying the requirement of propofol (used along with butorphanol) with and without the use of nitrous oxide in intracranial surgeries using bispectral index (BIS) monitoring. Material and methods: Fifty ASA grade I/II patients (16-60 years) scheduled for elective intracranial surgeries (≤ 4 hour duration) were included and were randomly allocated into two groups, group P and PN. All received IV midazolam and butorphanol at a dose of 30 μg/kg each. Anesthesia was induced with propofol and maintained on propofol with oxygen in air (1:1 ratio) in group P and nitrous oxide in oxygen (2:1 ratio) in group PN patients. BIS score of ≤ 40 at the time of endotracheal intubation, 50-60 during maintenance and ≥ 70 at extubation was maintained. The overall and maintenance dose requirement of propofol and the recovery profile were studied. Results: The overall and maintenance propofol doses were significantly higher in group P than group PN (100.02 ± 20.28 μg/kg/min Vs 79.62 ± 13.13μg/ kg/min; p<0.001) and (90.82 ± 19.13 Vs 71.26 ± 11.78 μg/kg/min; p<0.001) respectively. The recovery profiles were identical between groups. Conclusion: When used along with butorphanol the overall and maintenance doses of propofol without the use of nitrous oxide are 100.02 ± 20.28 μg/ kg/min and 90.82 ± 19.13 μg/ kg/min respectively which is more (p<0.001) than the dose required in combination with nitrous oxide (79.62 ± 13.13 and 71.26 ± 11.78 μg/kg/min respectively). © 2012 Dube SK, et al.