Browsing by Author "Dwivedi, Vandana"

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    A Real-world Pilot Observational Study of Neuropathic Pain Medications in Older Adult Patients in North India
    (Bentham Science Publishers, 2022) Kaur, Upinder; Dwivedi, Vandana; Singh, Alok; Singh, Amit; Pandey, Arun Raj; Acharya, Kumudini; Chakrabarti, Sankha Shubhra
    Aims: This pilot study aimed to make head-to-head comparisons of multiple classes of drugs used in the management of neuropathic pain in North Indian older adult patients pre-senting to the geriatric clinic of a tertiary medical institution. Background: Chronic neuropathic pain is a condition affecting nearly one third of older adults. There is paucity of data on head-to-head comparisons of drugs used in neuropathic pain in older adults. Real world studies may be a useful tool to study diverse neuropathic pain medications in this population. Objectives: The study objective was to measure NPRS (numeric pain rating scale), GDS (geri-atric depression scale), IADL (instrumental activities of daily living), HMSE (Hindi mental state examination) scores at baseline, and 4-and 12-week follow-ups in all older adult patients receiving neuropathic pain medications. Methods: A prospective observational study was conducted involving older adult patients ? 50 years of age with painful peripheral neuropathy of any etiology (n=60; mean age 63�8.4 years). The patients received either gabapentin, pregabalin, duloxetine, amitriptyline, or me-thyl-cobalamin complex. NPRS, GDS, IADL, and HMSE scores were measured at baseline and post-therapy. Results: All groups except amitriptyline showed statistically significant improvement in NPRS at 4 weeks and 12 weeks compared to baseline. 30% response rate at 4 weeks was maximum for pregabalin (72%) and 50% response rate at 12 weeks was maximum for gabapentin (58%). Numerically maximum improvement in depression was seen with duloxetine. There was no statistically significant difference in the measured parameters between the drug groups across time. Mean daily dose was 172 mg (gabapentin group), 75 mg (pregabalin group) and 20 mg (duloxetine group). The adverse drug reaction rate was 10.5%. Conclusion: All drug groups showed beneficial effects on neuropathic pain at much lower doses than those described in the literature. The effectiveness at these low doses and the lower rates of adverse effects sets the foundation for larger studies in the future in diverse ethnic and aged populations. � 2022 Bentham Science Publishers.
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    Intraperitoneal bupivacaine alone or with dexmedetomidine for post-operative analgesia following laparoscopic cholecystectomy: A prospective randomized comparative study
    (Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2022) Shankar, Shiv; Gupta, Bikram Kumar; Singh, Madhup Kumar; Pandey, Arun Raj; Dwivedi, Vandana; Sachan, Sumit
    Background & objetives: Laparoscopic procedures are usually followed by postoperative pain of variable intensity. The pain occurs due to streching of the visceral organs and peritoneum. We compared the antinociceptive effect of intraperitoneal instillation of bupivacaine with a combination of bupivacaine and dexmedetomidine in laparoscopic surgery. We assessed the quality of analgesia, time to the first request of rescue analgesia and total analgesics required in the first 24 h. Methodology: After institutional ethical committee approval a total of 162 patients were selected, out of which 81 patients were allocated into two groups using table of randomization. Group B received 0.25 % bupivacaine 50 ml with 5 ml normal saline and Group BD received 0.25 % bupivacaine 50 ml plus dexmedetomidine 1 ?g/kg diluted in 5 ml of normal saline intraperitoneally. Results: We found a significant difference between mean VAS scores of the two groups in all time points (p < 0.05). There was significant difference between mean time to the first request for analgesia and the mean total dose for analgesic required (p < 0.05) in between both groups. Conclusion: We conclude that intraperitoneal instillation of dexmedetomidine 1 ?g kg in combination with bupivacaine 0.25% in elective laparoscopic cholecystectomy significantly reduces the postoperative pain and analgesic requirement in postoperative period when compared to bupivacaine 0.25% alone. � 2022 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.