European Journal of Molecular & Clinical Medicine

Background and objectives: Epidural analgesia is a safe technique for post-operative pain relief and equivalent to traditional analgesic methods. Epidural narcotics have been extensively used for post- operative analgesia. In a quest to find a better and safer alternative to older drugs like morphine this study was undertaken to compare the safety and efficacy of postoperative analgesia with epidural butorphanol and epidural tramadol in patients undergoing orthopaedic lower limb surgeries.
Methods: A total of 100 patients of either sex, belonging to 20-60 yrs of age, ASA grade I and II admitted for orthopedic lower limb surgeries in the department of Anesthesiology, DMCH Darbhanga. were selected randomly for the study. Combined spinal-epidural was administered to all the patients. Postoperatively when patient complained of pain (Visual Analog Scale > 4), either butorphanol 1mg or tramadol 50mg diluted to 10ml was given epidurally and all the parameters were recorded.
Conclusion: Epidural butorphanol (1mg) is a safe and efficacious drug for post-operative analgesia. Epidural butorphanol provides a rapid, excellent but shorter duration of analgesia when compared to epidural tramadol. It has mild sedation which is advantageous in the postoperative period.

Background: Intraoperative pain control by means of local anesthesia is an intrinsic part of clinical practice in oral surgery. The present study compared efficacy of lignocaine, ropivacaine, and bupivacaine in control of pain during extraction of mandibular posterior teeth.
Materials & Methods: 90 patients of mandibular third molar surgical extractions of both genders were divided into 3 groups. Group I was third molar surgeries performed using 2% lignocaine with 1: 80,000 epinephrine, group II underwent surgical extractions of mandibular third molars under 0.75% ropivacaine local anesthesia. Group III were given bupivacaine. Each group has 30 patients. Subject response for pain was recorded using visual Analog Scale (VAS) and verbal Rating scale (VRS).
Results: Group I had 16 males and 14 females, group II had 15 males and 15 females and group III had 13 males and 17 females. VAS showed no pain in 20, 25 and 22, minimal pain in 10, 5 and 8. VRS showed little pain in 18, 28 and 20, moderate pain in 9, 2 and 10, severe pain in 2 and extreme pain in 1 respectively. The difference was significant (P< 0.05).
Conclusion: 0.75% ropivacaine is a better anesthetic when compared to bupivacaine and lignocaine for pain control during third molar extractions.

Objectives:Plantar fasciitis is a painful condition but can be self-limiting condition.
Among the different treatment which exit, physiotherapy and corticosteroid injection
are effective and popular. In this study, the author evaluated the efficacy of standard
care versus ultrasonography guided single dose of methylprednisolone acetate injection
for planar fasciopathy.
Design:This randomized clinical trial conducted in Physical Medicine & Rehabilitation
department of S M S medical college.
Method:Patients were allocated to standard care physiotherapy group (n=35) and
ultrasonography guided steroid injection group (n=35) equally. Pain and functional
ability on a visual analog scale (VAS), plantar fascia thickness and Foot Ankle
Disability Index (FADI) were evaluated at baseline and at 6 weeks after treatment.
Results:The mean age was not different between both groups (40.60±10.64 years versus
41.43±9.66 years, p=0.734). There was a reduction in VAS from baseline to weeks 6
(after treatment) (65.315±7.182 vs 32.57±4.235, respectively) (P<0.001). PF thickness at
6 weeks significantly reduced to 3.895±0.18 compared to baseline (P<0.001).FADI had a
considerable improved at week 6 (76.675±2.131) compared to baseline (62.915±1.823)
(P<0.001).
Conclusion:Both interventions caused improvement in pain and functional ability 2
months after treatment. Although inter difference were not significant.

Hemorrhoids are one of the most common anorectal diseases. Hemorrhoidectomy still stands as the most effective treatment for high grade hemorrhoids and postoperative acute pain as an expected result of hemorrhoidectomy has been experienced by thousands of patients all over the world and hence its only obstacle. Pain control using various invasive and noninvasive methods after hemorrhoidectomy has been constantly under debate and investigation. During the study period, 100 consecutive patients undergoing open hemorrhoidectomy under spinal anesthesia are allotted alternatively to each group. So 50 patients in each group of topical 2% diltiazem and diclofenac suppository. The diltiazem group yielded the lowest visual analog scale (VAS) score on post-operative day zero after surgery (p<0.05). The diclofenac group reported the lowest VAS score on following post-operative day one, two after surgery (p<0.05). There were no complications after treatment with either of these drugs. Topical use of diltiazem gel is appropriate for short-term pain control following hemorrhoidectomy, while diclofenac yields a more sustainable pain control.