Journal of the Indian Medical Association
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The sympathetic blocks are useful in many ways for relief of chronic pain. The sympathetic block can be caused at pre- and paravertebral sympathetic ganglia eg, stellate ganglia, coeliac plexus and lumbar sympathetic ganglia. Indications for sympathetic blockade are: Complex regional pain syndrome, phantom limb pain, central pain, acute pancreatitis, pancreatic cancer and cancer pain from upper abdominal viscera. ⋯ Coeliac plexus block is indicated in pain due to intra-abdominal cancer, stemming from organs innervated by coeliac plexus. Lumbar sympathetic block is indicated for diagnosis, prognosis and therapy for painful and other conditions associated with sympathetic dysfunctions like complex regional pain syndrome I and II, herpes zoster, amputation stump pain and inoperable peripheral vascular vasospastic diseases of the lower limb. Indications for superior hypogastric block are the prognostic and therapeutic purposes of cancer pelvic organs--uterus, cervix, bladder, prostate, urethra, testes and ovaries.
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Injury to central or peripheral nervous system causes neuropathic pain. Initially it affects the sensory nerves, then the motor nerves. In crush or traumatic injuries the sensory or motor nerves are affected simultaneously and the symptoms develop simultaneously. ⋯ The treatment modality can be subdivided into pharmacological pain management and interventional pain management. The following groups of drugs can be used either singularly or in combination in pharmacological pain management: Analgesics, anticonvulsants, antidepressants and miscellaneous group. Interventional pain management can be done by: Neural blockade, electric stimulation and implantable devices.
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Trigeminal neuralgia is the most frequent cranial neuralgia, the incidence being 1 per 1,000,00 persons per year. It presents with stabbing pain often in the distribution of the mandibular and maxillary divisions of the trigeminal nerve. An accurate history of pain is important in the diagnosis of trigeminal neuralgia. ⋯ Destructive procedures include (i) non-surgical methods--injections along trigeminal pathways, percutaneous trigeminal radiofrequency thermocoagulation and (ii) surgical methods--trigeminal branch avulsion or peripheral neurectomy, avulsion of trigeminal nerve, trigeminal tractotomy, radiosurgery. Though various modalities of treatment are available for the management of trigeminal neuralgia, pharmacotherapy with carbamazepine still remains the first line of treatment. The alternative approach followed at most centres is percuatenous Gasserian rhizolysis (chemical/radiofrequency thermal) or microvascular decompression.
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Noise, defined as any unwanted or undesirable sound, is a known environmental pollutant and health hazard. Sound levels during the entire surgical procedures were measured in the operation theatres (OTs) of a general hospital in Delhi, using a sound level meter, B & K 2209, on the dB(A) scale. ⋯ It is well documented that noise is stressful eliciting changes in the autonomic nervous system, impairing mental faculties and producing masking that could affect the staff and the conscious patient alike, leading to decreased work performance and increased anxiety respectively. Better acoustic designing and maintenance of equipment together with an increased awareness of the OT staff towards this vital factor of work environment may effectively reduce the noise pollution in OTs.