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ashok Jadon

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Irina Malkina-Pykh

Saint-Petersburg State University

Università Cattolica del Sacro Cuore (Catholic University of the Sacred Heart)

North Carolina State University

Università di Bologna

Muğla Sıtkı Koçman üniversitesi

Medical University of Vienna

University of Toronto

University of Utah

Conrado Alvarenga

Universidade de São Paulo

University Sains MalaysiaN

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Papers by ashok Jadon

In Response to “Preoperative Fluoroscopically Guided Regional Erector Spinae Plane Blocks Reduce Opioid Use, Increase Mobilization, and Reduce Length of Stay Following Lumbar Spine Fusion” by Owen et al

Global Spine Journal, Sep 16, 2021

We read with interest the recently published article “Preoperative Fluoroscopically Guided Region... more We read with interest the recently published article “Preoperative Fluoroscopically Guided Regional Erector Spinae Plane Blocks Reduce Opioid Use, Increase Mobilization, and Reduce Length of Stay Following Lumbar Spine Fusion” by Owen et al. At the outset we must congratulate the authors for their excellent work regarding use of erector spinae plane block (ESPB) for spine fusion surgery. ESPB as discussed by the authors have shown effective pain relief and reduction in opioid usage in cases of spinal fusion and helps in early mobilization. ESPB is primarily an ultrasound guided technique and was described by Forero et al, for neuropathic pain in the ribs and later on, it has been used for various other indication from cranium to sacrum. We were happy to note that authors have used an innovative approach of fluoroscopic guidance to give ESPB. However, their assumption that, it is the first time ever in the published literature, fluoroscopic guidance has been used to give ESPB, is not correct. We have used and published the fluoroscopic guided technique of ESPB to manage the cases of fractured rib. We have described the use of single injection technique as well as the catheter technique to give continuous analgesia and concluded that, it is feasible to give ESPB safely and effectively under fluoroscopic guidance. We do agree with the authors conclusion that, ESPB has a great potential for its use however; underutilized. ORCID iD

Stellate ganglion block: An approach to prevent oesophageal injury

Indian Journal of Anaesthesia, 2014

An Easy Solution For Successful Lumbar Plexus Block In Arthroplasty Surgery Of Patients With Poorly Defined Landmarks

Lumbar plexus block (LPB) provides excellent postoperative analgesia after major joint surgeries ... more Lumbar plexus block (LPB) provides excellent postoperative analgesia after major joint surgeries of lower limb (Hip and Knee joint) and when combined with sciatic nerve block it provides excellent surgical condition for such surgeries even in high risk patients. Various techniques, i.e. anatomical landmarks, nerve stimulator, ultrasound, CT (computed tomography) or MRI (Magnetic resonance imaging) guidance have been described for localization of lumbar plexus. We used combination of nerve stimulator and fluoroscopy for lumbar plexus block in six patients of arthoplastic surgery scheduled under block anaesthesia and had poorly defined anatomical landmarks thus resulted failed attempts for localization of transverse process of 4th lumbar vertebrae with nerve stimulator needle. With help of fluoroscopy transverse process of 4th lumbar vertebra was identified and block was given using nerve stimulator. Block was successful in all patients and no serious complication occurred in any of the patients.

Comparative evaluation of functional outcome and pain relief after pulsed radiofrequency of the saphenous nerve within and distal to the adductor canal in medial compartment knee osteoarthritis

Journal of Anaesthesiology Clinical Pharmacology, Oct 4, 2022

$Research paper thumbnail of Comparative evaluation of femoral nerve block and intravenous fentanyl for positioning during spinal anaesthesia in surgery of femur fracture$

Comparative evaluation of femoral nerve block and intravenous fentanyl for positioning during spinal anaesthesia in surgery of femur fracture

Indian Journal of Anaesthesia, 2014

Background: Spinal anaesthesia is the preferred technique to fix fracture of the femur. Extreme p... more Background: Spinal anaesthesia is the preferred technique to fix fracture of the femur. Extreme pain does not allow ideal positioning for this procedure. Intravenous fentanyl and femoral nerve block are commonly used techniques to reduce the pain during position for spinal anaesthesia however; results are conflicting regarding superiority of femoral nerve block over intravenous fentanyl. Aims: We conducted this study to compare the analgesic effect provided by femoral nerve block (FNB) and intravenous (IV) fentanyl prior to positioning for central neuraxial block in patients undergoing surgery for femur fracture. Patients and Methods: In this randomized prospective study 60 patients scheduled for fracture femur operation under spinal were included. Patients were distributed in two groups through computer generated random numbers table; Femoral nerve block group (FNB) and Intravenous fentanyl group (FENT). In FNB group patients received FNB guided by a peripheral nerve stimulator (Stimuplex; B Braun, Melsungen, AG) 5 minutes prior to positioning. 20mL, 1.5% lidocaine with adrenaline (1:200,000) was injected incrementally after a negative aspiration test. Patients in the fentanyl group received injection fentanyl 1 µg/ kg IV 5 mins prior to positioning. Spinal block was performed and pain scores before and during positioning were recorded. Statistical analysis was done with Sigmaplot version-10 computer software. Student t-test was applied to compare the means and P < 0.05 was taken as significant. Results: VAS during positioning in group FNB: 0.57 ± 0.31 versus FENT 2.53 ± 1.61 (P = 0.0020). Time to perform spinal anesthesia in group FNB: 15.33 ± 1.64 min versus FENT 19.56 ± 3.09 min (P = 0.000049). Quality of patient positioning for spinal anesthesia in group FNB 2.67± 0.606 versus FENT 1.967 ± 0.85 (P = 0.000027). Patient acceptance was less in group FENT (P = 0.000031). Conclusion: Femoral nerve block provides better analgesia, patient satisfaction and satisfactory positioning than IV fentanyl for position during spinal anaesthesia in patients of fracture femur.

Comparison of the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block versus thoracic erector spinae block for postoperative analgesia in caesarean section parturients under spinal anaesthesia-A randomised study

DOAJ (DOAJ: Directory of Open Access Journals), Jun 1, 2022

What is already known • Rectus sheath block is superior to local anesthesia infiltration for pedi... more What is already known • Rectus sheath block is superior to local anesthesia infiltration for pediatric patients undergoing umbilical hernia surgery. What this article adds • Rectus sheath block is quicker onset than local anesthesia infiltration for pediatric patients undergoing laparoscopic percutaneous extraperitoneal closure.

Epidural Naloxone to Prevent Buprenorphine Induced PONV

DOAJ (DOAJ: Directory of Open Access Journals), 2008

Epidural infusion of local analgesic and opioid are commonly used for postoperative pain relief. ... more Epidural infusion of local analgesic and opioid are commonly used for postoperative pain relief. This combination gives excellent anlgesia but nausea and vomiting remains a major concern. Low dose epidural naloxone prevents PONV induced by spinal opioids like morphine, fentanyl and sufentanil. However, it is not known that epidural naloxone administration prevents PONV induced by epidural buprenorphine. We have reported three of our cases of major abdominal operation in which lowdose epidural infusion of naloxone releived the symptom of buprenorphine induced severe PONV and improved the quality of analgesia.

Weakness of contralateral upper limb after interscalene block – A case report

Indian Journal of Anaesthesia, 2019

We have reported a case of right upper limb injury of shoulder and elbow who was managed with ult... more We have reported a case of right upper limb injury of shoulder and elbow who was managed with ultrasound-guided interscalene block during surgery and indwelling catheter for postoperative analgesia. He developed weakness in the contralateral upper limb in the postoperative period due to inadvertent spread of local anaesthetic in the cervical epidural space. No serious complication occurred due to timely intervention. The possible pathways of such unwanted epidural spread and methods to reduce such complications have been discussed.

Trigeminal Neuralgia in Pregnancy: A Management Challenge

Pain Practice, Jul 6, 2017

Pregnancy is known to aggravate pre-existing chronic painful conditions. Trigeminal neuralgia (TN... more Pregnancy is known to aggravate pre-existing chronic painful conditions. Trigeminal neuralgia (TN), albeit a disease of elderly may afflict pregnant females which can further complicate its management. Teratogenic effects of the commonly used drugs on the developing fetus limit pharmacological treatment. Moreover safety of commonly performed interventional therapies is marred by their inherent fetomaternal effects and more importantly the risk of radiation effects on fetus due to the use of fluoroscopy. This rare coexistence of TN in pregnancy is never reported before. Here, we present a case of trigeminal neuralgia in a young woman, whose pain aggravated when she became pregnant and was managed successfully by conventional radiofrequency ablation of Gasserian ganglion. This article is protected by copyright. All rights reserved.

Blood transfusion practices in obstetric anaesthesia

Indian Journal of Anaesthesia, 2014

Blood transfusion is an essential component of emergency obstetric care and appropriate blood tra... more Blood transfusion is an essential component of emergency obstetric care and appropriate blood transfusion significantly reduces maternal mortality. Obstetric haemorrhage, especially postpartum haemorrhage, remains one of the major causes of massive haemorrhage and a prime cause of maternal mortality. Blood loss and assessment of its correct requirement are difficult in pregnancy due to physiological changes and comorbid conditions. Many guidelines have been used to assess the requirement and transfusion of blood and its components. Infrastructural, economic, social and religious constraints in blood banking and donation are key issues to formulate practice guidelines. Available current guidelines for transfusion are mostly from the developed world; however, they can be used by developing countries keeping available resources in perspective.

Role of ultrasound guided transversus abdominis plane block as a component of multimodal analgesic regimen for lower segment caesarean section: a randomized double blind clinical study

BMC Anesthesiology, May 14, 2018

Background: While opioids are the mainstay for post-operative analgesia after lower segment caesa... more Background: While opioids are the mainstay for post-operative analgesia after lower segment caesarean section, they are associated with various untoward effects. Ultrasound guided transversus abdominis plane (TAP) block has been postulated to provide effective analgesia for caesarean section. We evaluated the analgesic efficacy of this block for post caesarean analgesia in a randomised controlled trial. Methods: One hundred thirty-nine mothers undergoing caesarean delivery were randomised to receive TAP block with either 20 ml 0.375% ropivacaine or 20 ml saline after obtaining informed consent. All the subjects received a standard spinal anaesthetic and diclofenac was administered for post-operative pain. Breakthrough pain was treated with tramadol. Post-operatively, all the subjects were assessed at 0, 2, 4, 6, 8, 10, 12, 18 & 24 h. The primary outcome was the time to first analgesic request. The secondary measures of outcome were pain, nausea, sedation, number of doses of tramadol administered and satisfaction with the pain management. Results: The median (interquartile range) time to first analgesic request was prolonged in the TAP group compared to the control group (p < 0.0001); 11 h (8,12) and 4 h (2.5,6) respectively. The median (interquartile range) number of doses of tramadol consumed in the TAP group was 0 (0,1) compared to 2 (1,2) in the control group (p < 0.0001). At all points in the study, pain scores both at rest and on movement were lower in the study group (p < 0.0001). Maternal satisfaction with pain relief was also higher in the study group (p 0.0002). One subject in the TAP group had convulsions following injection of local anaesthetic solution. She was managed conservatively with supportive treatment following which she recovered. Conclusion: TAP block reduces pain, prolongs the duration of analgesia and decreases supplemental opioid consumption when used for multimodal analgesia for pain relief after caesarean section. However, the risk of local anaesthetic systemic toxicity remains unknown with this block. Hence larger safety trials and measures to limit this complication need to be ascertained. Trial registration: The trial was registered with the Clinical Trial Registry of India (CTRI/2017/03/008194) on 23/03/2017 (trial registered retrospectively).

Suprascapular Nerve Block (SSNB) improves the outcome in exercise based management of Primary Adhesive Capsulitis (PAC): A prospective randomized comparative study

Journal of Anaesthesiology Clinical Pharmacology, Jan 11, 2022

Platelet-rich Plasma in Patients with Symptomatic Osteoarthritis Knee: An Evidence- and Consensus-based 2023 International Society for Musculoskeletal Ultrasound in Pain Medicine Guidelines

Journal on recent advances in pain, 2023

Review of: "Identification of Epidural Space: A Comparison Study Between Contrast Spread and Loss of Resistance Techniques

The article has poor scientific methods and absence of research question. This article concludes ... more The article has poor scientific methods and absence of research question. This article concludes that FOM (use of fluoroscopy) is better than LOR method. This is universal fact and does not provide a new insight in respect to cervical epidural injections because, many there are many known reasons for "FALSE" loss of resistance (LOR). Using 25G needle may be less painful however, inadvertent vascular placement would be difficult to detect in comparison to Tuohy needle. Lastly, if the aim was to establish the fact that, 25G needle can be used for cervical epidural with LOR is not acceptable by current safety standards. Even for Tuohy, only LOR method for cervical injections is not a safe practice.

Journal Scans

Jaypee Brothers Medical Publishers (P) Ltd. eBooks, 2018

Revalidation of a modified and safe approach of stellate ganglion block

Indian Journal of Anaesthesia, 2011

How to cite this article: Jadon A. Revalidation of a modified and safe approach of stellate gangl... more

Complications of regional and general anaesthesia in obstetric practice

Indian Journal of Anaesthesia, 2010

Any anaesthetic technique, either regional or general, has potential for complications. Moreover,... more Any anaesthetic technique, either regional or general, has potential for complications. Moreover, it has been seen that in obstetric patients, the complications are potentiated due to pregnancyrelated changes in physiology and due to various other factors. Increasing trend of caesarean section in the setting of increasing maternal age, obesity and other concomitant diseases will continue to challenge the obstetric anaesthetist in his/her task of providing safe regional and general anaesthesia. This review has highlighted the possible complications of regional and general anaesthesia encountered during the obstetric anaesthesia practice.

$Research paper thumbnail of In response to – “Three Blocks including Pericapsular Nerve Block (PENG) for a femoral shaft fracture pain” by Onur Koyuncu et al$

In response to – “Three Blocks including Pericapsular Nerve Block (PENG) for a femoral shaft fracture pain” by Onur Koyuncu et al

Brazilian Journal of Anesthesiology, Jul 1, 2020

Please cite this article in press as: Jadon A. In response to-''Three Blocks including Pericapsul... more

Functional Outcome and Pain Relief After Pulsed Radiofrequency of Saphenous Nerve in Medial Compartment Knee Osteoarthritis: A Randomised Double-Blind Trial

Journal of anesthesia and anesthetic drugs, May 26, 2022

Background and aims: Pulsed radiofrequency (PRF) of saphenous nerve (SN) has shown effective pain... more Background and aims: Pulsed radiofrequency (PRF) of saphenous nerve (SN) has shown effective pain relief in knee pain due to knee osteoarthritis (KOA). Since adductor canal (AC) contains other sensory nerves innervating the medial part of knee joint apart from SN. We compared the PRF of SN within and outside the AC for their quality and duration of pain relief in knee osteoarthritis of medial compartment (KOA-MC). Methods: We conducted a randomised prospective study in 60 patients with anteromedial knee pain due to KOA-MC. Patients in group A received PRF-SN and those in group B, PRF-AC. Primary objectives were, comparison of pain by visual analogue scale (VAS) score and changes in quality of daily living by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and OXFORD knee scores (OKS). Secondary objectives were, comparison of analgesic requirements using Medicine Quantification Scale (MQS) scale and block related complications. Intra group comparison was done by Analysis of variance (ANOVA). Inter group normally distributed data was assessed by student's t-test, non-normally distributed and ordinal data by Mann-Whitney U-test and categorical data by Chi-square test. A p value of < 0.05 was considered significant. Results: VAS scores were significantly lower in Gr-B at 12 weeks. The WOMAC scores and OXFORD scores at 4, 8, 12 and 24 weeks were significantly lower in Gr-B compared to Gr-A. Conclusion: The PRF-AC provides better pain relief and functional outcome than PRF-SN however, duration of pain relief was not significantly different.

Comment on "Spinal anaesthesia in poliomyelitis patients with scoliotic spine: A case control study

Indian Journal of Anaesthesia, 2013

In Response to “Preoperative Fluoroscopically Guided Regional Erector Spinae Plane Blocks Reduce Opioid Use, Increase Mobilization, and Reduce Length of Stay Following Lumbar Spine Fusion” by Owen et al

Global Spine Journal, Sep 16, 2021

We read with interest the recently published article “Preoperative Fluoroscopically Guided Region... more We read with interest the recently published article “Preoperative Fluoroscopically Guided Regional Erector Spinae Plane Blocks Reduce Opioid Use, Increase Mobilization, and Reduce Length of Stay Following Lumbar Spine Fusion” by Owen et al. At the outset we must congratulate the authors for their excellent work regarding use of erector spinae plane block (ESPB) for spine fusion surgery. ESPB as discussed by the authors have shown effective pain relief and reduction in opioid usage in cases of spinal fusion and helps in early mobilization. ESPB is primarily an ultrasound guided technique and was described by Forero et al, for neuropathic pain in the ribs and later on, it has been used for various other indication from cranium to sacrum. We were happy to note that authors have used an innovative approach of fluoroscopic guidance to give ESPB. However, their assumption that, it is the first time ever in the published literature, fluoroscopic guidance has been used to give ESPB, is not correct. We have used and published the fluoroscopic guided technique of ESPB to manage the cases of fractured rib. We have described the use of single injection technique as well as the catheter technique to give continuous analgesia and concluded that, it is feasible to give ESPB safely and effectively under fluoroscopic guidance. We do agree with the authors conclusion that, ESPB has a great potential for its use however; underutilized. ORCID iD

Stellate ganglion block: An approach to prevent oesophageal injury

Indian Journal of Anaesthesia, 2014

An Easy Solution For Successful Lumbar Plexus Block In Arthroplasty Surgery Of Patients With Poorly Defined Landmarks

Lumbar plexus block (LPB) provides excellent postoperative analgesia after major joint surgeries ... more Lumbar plexus block (LPB) provides excellent postoperative analgesia after major joint surgeries of lower limb (Hip and Knee joint) and when combined with sciatic nerve block it provides excellent surgical condition for such surgeries even in high risk patients. Various techniques, i.e. anatomical landmarks, nerve stimulator, ultrasound, CT (computed tomography) or MRI (Magnetic resonance imaging) guidance have been described for localization of lumbar plexus. We used combination of nerve stimulator and fluoroscopy for lumbar plexus block in six patients of arthoplastic surgery scheduled under block anaesthesia and had poorly defined anatomical landmarks thus resulted failed attempts for localization of transverse process of 4th lumbar vertebrae with nerve stimulator needle. With help of fluoroscopy transverse process of 4th lumbar vertebra was identified and block was given using nerve stimulator. Block was successful in all patients and no serious complication occurred in any of the patients.

Comparative evaluation of functional outcome and pain relief after pulsed radiofrequency of the saphenous nerve within and distal to the adductor canal in medial compartment knee osteoarthritis

Journal of Anaesthesiology Clinical Pharmacology, Oct 4, 2022

$Research paper thumbnail of Comparative evaluation of femoral nerve block and intravenous fentanyl for positioning during spinal anaesthesia in surgery of femur fracture$

Comparative evaluation of femoral nerve block and intravenous fentanyl for positioning during spinal anaesthesia in surgery of femur fracture

Indian Journal of Anaesthesia, 2014

Background: Spinal anaesthesia is the preferred technique to fix fracture of the femur. Extreme p... more Background: Spinal anaesthesia is the preferred technique to fix fracture of the femur. Extreme pain does not allow ideal positioning for this procedure. Intravenous fentanyl and femoral nerve block are commonly used techniques to reduce the pain during position for spinal anaesthesia however; results are conflicting regarding superiority of femoral nerve block over intravenous fentanyl. Aims: We conducted this study to compare the analgesic effect provided by femoral nerve block (FNB) and intravenous (IV) fentanyl prior to positioning for central neuraxial block in patients undergoing surgery for femur fracture. Patients and Methods: In this randomized prospective study 60 patients scheduled for fracture femur operation under spinal were included. Patients were distributed in two groups through computer generated random numbers table; Femoral nerve block group (FNB) and Intravenous fentanyl group (FENT). In FNB group patients received FNB guided by a peripheral nerve stimulator (Stimuplex; B Braun, Melsungen, AG) 5 minutes prior to positioning. 20mL, 1.5% lidocaine with adrenaline (1:200,000) was injected incrementally after a negative aspiration test. Patients in the fentanyl group received injection fentanyl 1 µg/ kg IV 5 mins prior to positioning. Spinal block was performed and pain scores before and during positioning were recorded. Statistical analysis was done with Sigmaplot version-10 computer software. Student t-test was applied to compare the means and P < 0.05 was taken as significant. Results: VAS during positioning in group FNB: 0.57 ± 0.31 versus FENT 2.53 ± 1.61 (P = 0.0020). Time to perform spinal anesthesia in group FNB: 15.33 ± 1.64 min versus FENT 19.56 ± 3.09 min (P = 0.000049). Quality of patient positioning for spinal anesthesia in group FNB 2.67± 0.606 versus FENT 1.967 ± 0.85 (P = 0.000027). Patient acceptance was less in group FENT (P = 0.000031). Conclusion: Femoral nerve block provides better analgesia, patient satisfaction and satisfactory positioning than IV fentanyl for position during spinal anaesthesia in patients of fracture femur.

Comparison of the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block versus thoracic erector spinae block for postoperative analgesia in caesarean section parturients under spinal anaesthesia-A randomised study

DOAJ (DOAJ: Directory of Open Access Journals), Jun 1, 2022

What is already known • Rectus sheath block is superior to local anesthesia infiltration for pedi... more What is already known • Rectus sheath block is superior to local anesthesia infiltration for pediatric patients undergoing umbilical hernia surgery. What this article adds • Rectus sheath block is quicker onset than local anesthesia infiltration for pediatric patients undergoing laparoscopic percutaneous extraperitoneal closure.

Epidural Naloxone to Prevent Buprenorphine Induced PONV

DOAJ (DOAJ: Directory of Open Access Journals), 2008

Epidural infusion of local analgesic and opioid are commonly used for postoperative pain relief. ... more Epidural infusion of local analgesic and opioid are commonly used for postoperative pain relief. This combination gives excellent anlgesia but nausea and vomiting remains a major concern. Low dose epidural naloxone prevents PONV induced by spinal opioids like morphine, fentanyl and sufentanil. However, it is not known that epidural naloxone administration prevents PONV induced by epidural buprenorphine. We have reported three of our cases of major abdominal operation in which lowdose epidural infusion of naloxone releived the symptom of buprenorphine induced severe PONV and improved the quality of analgesia.

Weakness of contralateral upper limb after interscalene block – A case report

Indian Journal of Anaesthesia, 2019

We have reported a case of right upper limb injury of shoulder and elbow who was managed with ult... more We have reported a case of right upper limb injury of shoulder and elbow who was managed with ultrasound-guided interscalene block during surgery and indwelling catheter for postoperative analgesia. He developed weakness in the contralateral upper limb in the postoperative period due to inadvertent spread of local anaesthetic in the cervical epidural space. No serious complication occurred due to timely intervention. The possible pathways of such unwanted epidural spread and methods to reduce such complications have been discussed.

Trigeminal Neuralgia in Pregnancy: A Management Challenge

Pain Practice, Jul 6, 2017

Pregnancy is known to aggravate pre-existing chronic painful conditions. Trigeminal neuralgia (TN... more Pregnancy is known to aggravate pre-existing chronic painful conditions. Trigeminal neuralgia (TN), albeit a disease of elderly may afflict pregnant females which can further complicate its management. Teratogenic effects of the commonly used drugs on the developing fetus limit pharmacological treatment. Moreover safety of commonly performed interventional therapies is marred by their inherent fetomaternal effects and more importantly the risk of radiation effects on fetus due to the use of fluoroscopy. This rare coexistence of TN in pregnancy is never reported before. Here, we present a case of trigeminal neuralgia in a young woman, whose pain aggravated when she became pregnant and was managed successfully by conventional radiofrequency ablation of Gasserian ganglion. This article is protected by copyright. All rights reserved.

Blood transfusion practices in obstetric anaesthesia

Indian Journal of Anaesthesia, 2014

Blood transfusion is an essential component of emergency obstetric care and appropriate blood tra... more Blood transfusion is an essential component of emergency obstetric care and appropriate blood transfusion significantly reduces maternal mortality. Obstetric haemorrhage, especially postpartum haemorrhage, remains one of the major causes of massive haemorrhage and a prime cause of maternal mortality. Blood loss and assessment of its correct requirement are difficult in pregnancy due to physiological changes and comorbid conditions. Many guidelines have been used to assess the requirement and transfusion of blood and its components. Infrastructural, economic, social and religious constraints in blood banking and donation are key issues to formulate practice guidelines. Available current guidelines for transfusion are mostly from the developed world; however, they can be used by developing countries keeping available resources in perspective.

Role of ultrasound guided transversus abdominis plane block as a component of multimodal analgesic regimen for lower segment caesarean section: a randomized double blind clinical study

BMC Anesthesiology, May 14, 2018

Background: While opioids are the mainstay for post-operative analgesia after lower segment caesa... more Background: While opioids are the mainstay for post-operative analgesia after lower segment caesarean section, they are associated with various untoward effects. Ultrasound guided transversus abdominis plane (TAP) block has been postulated to provide effective analgesia for caesarean section. We evaluated the analgesic efficacy of this block for post caesarean analgesia in a randomised controlled trial. Methods: One hundred thirty-nine mothers undergoing caesarean delivery were randomised to receive TAP block with either 20 ml 0.375% ropivacaine or 20 ml saline after obtaining informed consent. All the subjects received a standard spinal anaesthetic and diclofenac was administered for post-operative pain. Breakthrough pain was treated with tramadol. Post-operatively, all the subjects were assessed at 0, 2, 4, 6, 8, 10, 12, 18 & 24 h. The primary outcome was the time to first analgesic request. The secondary measures of outcome were pain, nausea, sedation, number of doses of tramadol administered and satisfaction with the pain management. Results: The median (interquartile range) time to first analgesic request was prolonged in the TAP group compared to the control group (p < 0.0001); 11 h (8,12) and 4 h (2.5,6) respectively. The median (interquartile range) number of doses of tramadol consumed in the TAP group was 0 (0,1) compared to 2 (1,2) in the control group (p < 0.0001). At all points in the study, pain scores both at rest and on movement were lower in the study group (p < 0.0001). Maternal satisfaction with pain relief was also higher in the study group (p 0.0002). One subject in the TAP group had convulsions following injection of local anaesthetic solution. She was managed conservatively with supportive treatment following which she recovered. Conclusion: TAP block reduces pain, prolongs the duration of analgesia and decreases supplemental opioid consumption when used for multimodal analgesia for pain relief after caesarean section. However, the risk of local anaesthetic systemic toxicity remains unknown with this block. Hence larger safety trials and measures to limit this complication need to be ascertained. Trial registration: The trial was registered with the Clinical Trial Registry of India (CTRI/2017/03/008194) on 23/03/2017 (trial registered retrospectively).

Suprascapular Nerve Block (SSNB) improves the outcome in exercise based management of Primary Adhesive Capsulitis (PAC): A prospective randomized comparative study

Journal of Anaesthesiology Clinical Pharmacology, Jan 11, 2022

Platelet-rich Plasma in Patients with Symptomatic Osteoarthritis Knee: An Evidence- and Consensus-based 2023 International Society for Musculoskeletal Ultrasound in Pain Medicine Guidelines

Journal on recent advances in pain, 2023

Review of: "Identification of Epidural Space: A Comparison Study Between Contrast Spread and Loss of Resistance Techniques

The article has poor scientific methods and absence of research question. This article concludes ... more The article has poor scientific methods and absence of research question. This article concludes that FOM (use of fluoroscopy) is better than LOR method. This is universal fact and does not provide a new insight in respect to cervical epidural injections because, many there are many known reasons for "FALSE" loss of resistance (LOR). Using 25G needle may be less painful however, inadvertent vascular placement would be difficult to detect in comparison to Tuohy needle. Lastly, if the aim was to establish the fact that, 25G needle can be used for cervical epidural with LOR is not acceptable by current safety standards. Even for Tuohy, only LOR method for cervical injections is not a safe practice.

Journal Scans

Jaypee Brothers Medical Publishers (P) Ltd. eBooks, 2018

Revalidation of a modified and safe approach of stellate ganglion block

Indian Journal of Anaesthesia, 2011

How to cite this article: Jadon A. Revalidation of a modified and safe approach of stellate gangl... more

Complications of regional and general anaesthesia in obstetric practice

Indian Journal of Anaesthesia, 2010

Any anaesthetic technique, either regional or general, has potential for complications. Moreover,... more Any anaesthetic technique, either regional or general, has potential for complications. Moreover, it has been seen that in obstetric patients, the complications are potentiated due to pregnancyrelated changes in physiology and due to various other factors. Increasing trend of caesarean section in the setting of increasing maternal age, obesity and other concomitant diseases will continue to challenge the obstetric anaesthetist in his/her task of providing safe regional and general anaesthesia. This review has highlighted the possible complications of regional and general anaesthesia encountered during the obstetric anaesthesia practice.

$Research paper thumbnail of In response to – “Three Blocks including Pericapsular Nerve Block (PENG) for a femoral shaft fracture pain” by Onur Koyuncu et al$

In response to – “Three Blocks including Pericapsular Nerve Block (PENG) for a femoral shaft fracture pain” by Onur Koyuncu et al

Brazilian Journal of Anesthesiology, Jul 1, 2020

Please cite this article in press as: Jadon A. In response to-''Three Blocks including Pericapsul... more

Functional Outcome and Pain Relief After Pulsed Radiofrequency of Saphenous Nerve in Medial Compartment Knee Osteoarthritis: A Randomised Double-Blind Trial

Journal of anesthesia and anesthetic drugs, May 26, 2022

Background and aims: Pulsed radiofrequency (PRF) of saphenous nerve (SN) has shown effective pain... more Background and aims: Pulsed radiofrequency (PRF) of saphenous nerve (SN) has shown effective pain relief in knee pain due to knee osteoarthritis (KOA). Since adductor canal (AC) contains other sensory nerves innervating the medial part of knee joint apart from SN. We compared the PRF of SN within and outside the AC for their quality and duration of pain relief in knee osteoarthritis of medial compartment (KOA-MC). Methods: We conducted a randomised prospective study in 60 patients with anteromedial knee pain due to KOA-MC. Patients in group A received PRF-SN and those in group B, PRF-AC. Primary objectives were, comparison of pain by visual analogue scale (VAS) score and changes in quality of daily living by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and OXFORD knee scores (OKS). Secondary objectives were, comparison of analgesic requirements using Medicine Quantification Scale (MQS) scale and block related complications. Intra group comparison was done by Analysis of variance (ANOVA). Inter group normally distributed data was assessed by student's t-test, non-normally distributed and ordinal data by Mann-Whitney U-test and categorical data by Chi-square test. A p value of < 0.05 was considered significant. Results: VAS scores were significantly lower in Gr-B at 12 weeks. The WOMAC scores and OXFORD scores at 4, 8, 12 and 24 weeks were significantly lower in Gr-B compared to Gr-A. Conclusion: The PRF-AC provides better pain relief and functional outcome than PRF-SN however, duration of pain relief was not significantly different.

Comment on "Spinal anaesthesia in poliomyelitis patients with scoliotic spine: A case control study

Indian Journal of Anaesthesia, 2013