Cervicogenic angina is paroxysmal precordialgia usually due to lower cervical vertebral involvement. But upper cervical vertebral segmental anomaly causing cervicogenic angina is rare. Herein, we report a case of cervicogenic angina due to fused 3 ^rd and 4 ^th cervical vertebra in a 37-year female, which was initially misdiagnosed as angina and treated likewise. But, persistence of symptoms led to evaluation of her cervical spine and subsequent diagnosis. Cervical traction, physiotherapy and posture training relieved her of her symptoms with no recurrence till 6 months of follow-up. Fused C3-C4 can be a cause of precordialgia and physicians should be aware of it.

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Background: Nalbuphine is a synthetic opioid with mixed agonist-antagonist action, when added as adjuvant to intrathecal bupivacaine acts on kappa receptors in the dorsal horn of the spinal cord producing analgesia. Aim: To evaluate the onset of sensory block, hemodynamic changes, duration and quality of analgesia, and adverse effects of different doses of nalbuphine with bupivacaine for spinal anesthesia. Materials and Methods: Randomized double blind study done on 100 patients undergoing lower abdominal and lower limb orthopedic surgeries under subarachnoid block. Patients were randomly allocated to four groups receiving either intrathecal 15 mg of bupivacaine + 0.5 mL normal saline alone or 15 mg of bupivacaine with either of nalbuphine 0.8, 1.6, and 2.5 mg + 0.5 mL normal saline. Results: The mean visual analogue scale score in group A is 4.08 ± 0.5 and in groups B, C, and D are 3.4 ± 0.4, 3.5 ± 0.5, and 3.5 ± 0.5, respectively. The duration of analgesia in group A is 190.4 ± 20.0 and in groups B, C, and D were 322.4 ± 31.1, 319 ± 39.8 and 317.8 ± 47.5. The quality of analgesia was good in 72%-76% and excellent in 16%-28% in groups B, C, and D and poor 28% to satisfactory 72% in group A. Conclusion: Addition of 0.8 mg of nalbuphine to 0.5% bupivacaine for subarachnoid block provides excellent analgesia with longer duration of action compared with 1.6 and 2.4 mg of nalbuphine.

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The sensation of pain is an indication that something is wrong somewhere in the body. Pain and inflammation may be linked by cyclooxygenase (COX) enzymes most especially COX ₂ , which help in the synthesis of prostaglandins (PGs) precisely PGE2 and PGF2a, found in high concentration at the inflammatory site. The released PGs either stimulate pain receptor or sensitized pain receptors to the action of other pain producing substances such as histamine, 5-hydroxytryptamine (5HT), bradykinin which initiate and cause the nerve cells to send electrical pain impulse to the brain. In the present review, an attempt is made to unveil the treatment approach adopted in the management of pain and inflammation as well as animal models used in evaluating herbal plants with analgesic and anti-inflammatory properties. The choice of the use of herbal medicine have been encouraged due to it availability, affordability, accessibility, and little or no side effect associated with it. However, the question remains can herbal therapy serves as an alternative to available conventional drugs. Different treatment options in the management of pain and inflammation have been highlighted.

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Painful ophthalmoplegia refers to a multiple cranial nerve syndrome involving oculomotor, trochlear, abducens, and ophthalmic division of the trigeminal nerve. Among various etiologies of painful ophthalmoplegias, Tolosa-Hunt syndrome, a relatively benign condition, used to be a diagnosis of exclusion. With advent of newer imaging techniques, it can now be considered as primary differential in painful ophthalmoplegias and patient can benefit with early introduction of steroids. We describe herein a patient with painful ophthalmoplegia in which early diagnosis was made, based on clinical and magnetic resonance imaging (MRI) findings.

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Background: Caudal block is a common technique for pediatric analgesia, but with the disadvantage of short duration of action after single injection. We compared the analgesic effects and side-effects of dexmedetomidine and clonidine added to ropivacaine in pediatric patients undergoing lower abdominal surgeries. Materials and Methods: A study was conducted among 60 pediatric patients undergoing lower abdominal surgeries. A total of 60 American Society of Anesthesiologists (ASA) status I and II pediatric patients between the age of 1 and 6 years were enrolled in this study. The caudal block was administered with inj. ropivacaine 0.2% with clonidine 2 μg/kg (group A) and inj. ropivacaine 0.2% with dexmedetomidine 2 μg/kg (group B) after induction with general anesthesia. Hemodynamic parameters were observed before, during, and after the surgical procedure. Postoperative analgesic duration, total dose of rescue analgesia, pain scores, and any side effects were looked for and recorded. Results: Addition of dexmedetomidine or clonidine to caudal ropivacaine significantly promoted analgesic time. Also, there was statistically significant difference between dexmedetomidine and clonidine as regard to duration of analgesia. No significant difference was observed in incidence of hemodynamic changes or side effects. Conclusions: Addition of dexmedetomidine or clonidine to caudal ropivacaine significantly promoted analgesia in children undergoing lower abdominal surgeries with significant advantage of dexmedetomidine over clonidine and without an increase in incidence of side-effects.

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Pain causes a reflex withdrawal from any stimuli that can cause actual or potential tissue damage. It is frequently an early symptom of a disease process and is often the impetus for a patient to seek medical treatment. In many disorders where pain appears late, patients are at risk of developing complications without getting noticed. 'Congenital insensitivity to pain' is a rare disorder. Traumatic injury and self-mutilation is an almost consistent feature in this disorder. Injuries most frequently involve the oral and paraoral structures such as teeth, lips, tongue, and also ears, eyes, nose, and fingers. Oral manifestations may be the presenting complaint. Thus, it is important for the clinicians to be familiar with the condition. The present article provides a brief review of the condition and its insinuation in dentistry.

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Introduction: IVRA is safe, technically simple, and cost effective technique compared to general anaesthesia with success rates of 94 to 98% for upper and lower limb surgeries. It also provides bloodless field during surgery. To overcome these disadvantages various adjuvants have been tried. We compared Fentanyl and tramadol as adjuvants to lignocaine for IVRA for upper limb surgeries. Material and Method: After approval from institutional ethical committee, 60 patients of either sex belonging to ASA grade I and II, in the age range of 20 to 60 years scheduled to undergo upper limb orthopaedic surgery either elective or emergency were included in the study. All the patients were administered intravenous regional anaesthesia (IVRA) after obtaining written informed consent. Patients enrolled in the study were divided into 2 groups of 30 each by a computer generated Randomization program. Group LF-received 40 ml of 0.5% Lignocaine with Fentanyl 1 ug/kg. Group LT-received 40 ml of 0.5% Lignocaine with Tramadol 1 mg/kg. Double tourniquet technique was used. The arm was exsanguinated with Eschmark bandage and proximal cuff was inflated followed by injection of the study drug. Parameters observed were time of onset of sensory and motor block, intraoperative conditions post operative analgesia and adverse effects. Data was expressed as mean ± SD (Standard Deviation) of statistical analysis. Statistical Analysis was done by using Discriptive and Inferencial statistics using chi-square test and students unpaired t-test. The software used in analysis were SPSS 17.0 version and Graph Pad Space Prism 5.0 and results were tested at 5% level of significance. Results: Patients were comparable demographically. Mean values of onset of sensory blockade was 6.76 ± 1.30 min in Group LT and 7.13 ± 0.81 min in Group LF.

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Introduction: High incidences of Buerger's disease (43-62%) in India draw our attention towards available treatment modalities in such patients. Patients with this disease are in severe pain and agony. Pain relief by any means remains first and foremost priority in such patients and if patient is able to sleep even one pain free night it is a boon for the patients. The purpose of study was to test the hypothesis that lumber sympathetic block relieves the pain of ischemic limb in Buerger's disease. Aims and Objectives: To study the effect of chemical lumber sympathetic block on visual analog score (VAS) score and walking distance of the patients. Materials and Methods: Lumber sympathetic block was given under C-arm guidance with 17.5 cm long 22 G spinal needle at L3 and L4 level. Diagnostic block was given initially with plain bupivacaine 0.25% with two needle technique. Total seven blocks series were given in all patients. Final block was given with phenol 8%, 8 ml at L3 and L4 level. In postoperative period, VAS score was observed. Effect of block on walking distance was assessed on 3 ^rd day before giving next block. Statistical analysis: Software Statistical Package for Social Sciences (SPSS) version 11.5 was used for statistical analysis. Data were analyzed by paired t-test and P-value < 0.05 was considered as significant. Results: Both VAS and walking distance improved significantly after each successive block. Healing of ulcers of foot is also noted. Conclusion: Despite advances in treatment modalities in such patients, lumber sympathetic block is still very cost-effective, safe, and least-invasive technique in treating painful ischemic legs.

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This is a case report of a patient (man, 65 year, 70 kg) with severe abdominal and lower extremity pain. Diagnostic methods including color Doppler ultrasound, computed tomography (CT) with contrast, and CT angiography showed thrombosis in abdominal artery near bifurcation of superior mesenteric artery. His pain did not respond to abdominal thromboembolectomy and intravenous injection of heparin and then opioid and acetaminophen. After continuous infusion of lidocaine and nitroglycerin, pain decrease about 20% and after 48 h, it decreases to 80%. This method may be a good option for pain management of acute ischemic pain due to acute arterial occlusion.

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