European Journal of Molecular & Clinical Medicine

Introduction: One of the most common surgery done by otorhinolaryngolist in India is tonsillectomy. Since tonsillectomy leaves a open wound in the pharyngeal wall causing post tonsillectomy pain. Inadequate post tonsillectomy pain control will lead to severe distress, dehydration, discomfort.

Background: Subacromial Impingement Syndrome is the common cause for shoulder pain caused due to pathology in one or more of the structures present in the Subacromial area. The discomfort is linked to a loss of shoulder function and difficulty performing regular everyday activities. The pathophysiology is not entirely understood. The Subacromial injection was developed to reach a high drug concentration at the site of pathology while using a less overall drug to avoid systemic side effects. Triamcinolone Acetonide produces both anti-inflammatory and direct analgesic benefits in the shoulder.
Material and Methods: This study included 55 patients with Age more than 20 and Pain during Shoulder Arc of Motion, Positive Neer’s Sign and Hawkin’s Test. Pain during Shoulder Arc of motion, Visual Analogue Scale Score and Shoulder Pain and Disability Index was calculated pre injection and post injection at 2,6 and 12 weeks. Data was collected and analyzed statistically.
Results: 55 cases were worked up on OPD Basis. Mean age was 50.69, Male dominance. Pain during Shoulder Arc of Motion which was initially present in all 55 patients decreased over the follow-ups and at the end of 12 weeks only 3 patients had persistent pain. Visual Analogue Scale Median at 0 weeks was 9 which decreased to 0 at 12 weeks, Shoulder Pain and Disability Index Median at 0 weeks was 82.3 which decreased to 3.07 at 12 weeks. All these changes were significant with p value < 0.001.
Conclusion: We conclude that in our patients suffering from Subacromial Impingement Syndrome post subacromial injection under C-ARM guidance with Triamcinolone Acetonide, the results measured by Pain during Shoulder Arc of Motion, VAS Score and SPADI showed significant improvement. Thus, We support that Subacromial injection of Triamcinolone Acetonide is safe, economical and effective in the treatment of patients suffering from Subacromial Impingement Syndrome

Introduction: Shoulder pain is the most common complaints in medicine and disorders attributed to the rotator cuff are the most common cause of shoulder pain. More than 50% of all shoulder pains are considered to be that related to tendinopathies of the rotator cuff, as supraspinatus in complete thickness tears and tendinosis1. Platelet rich plasma (PRP) is a preparation of concentrated autologous platelets containing growth factors and bio active substances essential to musculoskeletal healing. It involves minimum risk of immune reactions and transmission of infectious and contagious disease. With this we need assess the efficacy of PRP shoulder.

Pain management, stable hemodynamics and early post-operative recovery are the new challenges in ambulatory surgeries. The literature rates post-operative pain in laproscopic cholecystectomy as mild to severe pain. Our objective is to assess the post-operative analgesia with intravenous paracetamol versus dexmedetomidine in patients undergoing laproscopic cholecystectomy.
Methods: After ethical committee clearance, 60 patients were randomly allocated into two groups after informed consent. Patients between 18-50 years, ASA 1or 2 were included and those on opioids, any anti-inflammatory drugs, and hypersensitivity to study drugs were excluded. Group D received intravenous dexmedetomidine 1μg/kg as bolus over 10 min followed by dexmedetomidine infusion at 0.25ml/kg/h (0.25ml = 0.5μg). Group P received 1 g intravenous paracetamol in 100ml solution of normal saline over 10 min followed by infusion of 0.25ml/kg/h of normal saline.
Results: Demographic parameters were comparable between the groups. Time for first rescue analgesia, and total doses of analgesia in 24 h in group D was 225.33±29.12 and 2.73±0.64 and in group P was 143.33±28.96 and 4.23±0.77 respectively with p value 0.001 which was statistically significant.
Conclusion: Dexmedetomidine loading dose 1μg/kg and maintenance dose 0.5μg/kg is a good anesthetic adjuvant for general anesthesia to reduce post-operative requirement of analgesia in laparoscopic surgeries.

Introduction: Pain and decreased ROM is a common presenting condition to orthopaedic outpatient department. Primary Frozen shoulder is estimated to affect 3 to 5% of the general population since PRP is an autologous biologic material, it involves a minimum risk of Immune reactions and transmission of infectious and contagious disease. With this we need assess the efficacy of PRP Shoulder.
Aim and Objective: To assess the efficacy of Platelet Rich plasma in periarthritis shoulder.
Methods: This study included 50 patients diagnosed with periarthritis shoulder and were recruited from the outpatient department of orthopaedics, VIMS, Bellary from the period between November 2018 -2020. The study included both sexes. All patients were injected intraarticularly with PRP. They were evaluated by visual Analogue scale (VAS) for pain and a shortened version of disabilities of arm, shoulder and hand using DASH score for function.
Results: Descriptive and inferential statistical analysis has been carried out in the present study Descriptive and inferential statistical analysis has been carried out in the present study using Student ‘t’ test (two tailed, dependent & independent) and Fisher test. The improvement in VAS score and DASH scores at 3rd, 6th and 12th week follow up in patients who received PRP injections was statistically more significant compared to scores at the time of admission as inferred by p value of <0.05. Using Student ‘t’ test (two tailed, dependent & independent) and Fisher test. The improvement in VAS score and DASH scores at 3rd, 6th and 12th week follow up in patients who received PRP injections was statistically more significant compared to scores at the time of admission as inferred by p value of <0.05.
Interpretation & Conclusion: Our study concludes that the efficacy of single injection of platelet rich plasma to relieve the pain of Periarthritis shoulder is effective less-invasive lines of treatment over a short term follow up period. However more studies are required to evaluate the efficacy of PRP over long term with multi centric study & comparison with the current available treatment options.

INTRODUCTION: Total knee arthroplasty (TKA) is one of the best methods for end stage osteoarthritis of knee joint that relieves pain and improves joint function. Most important problem which the patient suffers is postoperative pain, which has harmful effects on patient’s rehabilitation. The aim of our study was to assess the postoperative pain relief and functional outcome following use of combination of drugs which we used as intraoperative, periarticular cocktail injection.
MATERIALS AND METHODS: It is a prospective interventional study consisting of 40 TKA’s done in a single unit. All patients underwent TKA under spinal anaesthesia and underwent standard postoperative protocol. Intraoperative periarticular cocktail consisting of Bupivacaine 0.5% (20ml), Adrenaline 0.3 ml (1:1000), ketorolac 30mg/1ml, methylprednisolone 40mg//1ml, cefuroxime 750mg/10ml with 27.7 ml of normal saline to make total of 60ml solution was given. Assessment of pain was done by visual analogue scale (VAS) and functional assessment by knee society score postoperatively. The number of rescue analgesia used was recorded. 
RESULTS: Mean age of patients was 64 years (47-76) with females predominantly affected than males. Mean static VAS at 6 hours was 4.3 and dynamic VAS at 1^st recording was 4.9. there was a strong correlation between Body Mass Index and Dynamic VAS at 1^st and Dynamic VAS at 3^rd   recording with p < 0.05. Patient satisfaction and functional scores improved postoperatively and there was a statistically significant improvement in knee ROM (P< 0.05). only 2 patients received more than 3 doses of rescue analgesia due to high BMI. No complications related to the infiltration of the local anaesthetic were observed.