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Dermatomal analgesia achieved with quadratus lumborum blocks is site-dependent and inconsistent. Cadaveric and clinical studies reveal multiple mechanisms of action. We dissected six fresh human cadavers bilaterally and thoroughly studied their neurological linkages to the quadratus lumborum muscle (QLM) to identify neural structures and block targets. At the end of the investigation, only the subcostal nerve (anterolateral) and the ilioinguinal nerves were found near the QLM in all specimens. The iliohypogastric nerve was found in only two specimens. No further neural targets were found in the fascial planes before and posterior to the QLM. Keywords: Cadaver, dissection, nerve block, quadratus lumborum, Author(s): Sandeep Diwan [1]; Xavier S. Blanch [2]; Abhijit S. Nair (corresponding author) [3] INTRODUCTION Three common approaches to quadratus lumborum block (QLB) have been described depending on the site [...]

Byline: Sandeep. Diwan, Divya. Sethi, Sudhakar. Jadhav, Santosh. Patil In this case series, we investigated the feasibility of combining ultrasound and neurostimulation for inserting a stimulating epidural catheter in the [...]

Byline: Sandeep. Diwan, Archana. Areti, T. Sivashanmugam, Parag. Sancheti Introduction Closed reduction and internal fixation (CRIF) with proximal femur nail (PFN) performed under lumbosacral plexus block (LSPB) as a sole [...]

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Byline: Pallavi. Pai, Sandeep. Diwan, Parag. Sancheti Introduction Ultrasonography is a safe and excellent method of imaging peripheral nerves and has revolutionised regional anaesthesia practice.[1] Ultrasound-guided supraclavicular brachial plexus block [...]

Byline: Abhijit. Nair, Sandeep. Diwan Sir, Medication administration errors can have catastrophic outcomes if a drug is inadvertently administered via the wrong route. Regional anaesthesia involves the use of drugs [...]

Byline: T. Sivashanmugam, Archana. Areti, E. Selvum, Sandeep. Diwan, Arun. Pandian Background and Aims: Commonly, the superficial cervical plexus and interscalene block were combined to provide surgical anaesthesia for procedures [...]

Background: Paraneural sheath engulfing the sciatic nerve (SN) between the ischial tuberosity and the greater trochanter is well known. Methods: In order to explore the anatomical planes separating the paraneurium from the epineurium in SN, we conducted a cadaveric study (two patients and four specimens), followed by a clinical study in 10 patients. Results: We demonstrated an elevation of 5–7 layers of paraneural tissues after an in-plane injection in the longitudinal axis of the proximal SN, which was possibly the last of the paraneural sheath. In the clinical study, the block provided low pain scores with no rescue analgesia postoperatively and no neurological deficit at the time of discharge. Conclusion: This is probably the first series which has described the elevation of several layers of paraneural tissues after an in-plane injection in the longitudinal axis of the proximal SN. [ABSTRACT FROM AUTHOR]

Background: Severe abdominal pain refractory to opioids significantly affects the quality of life (QoL) in patients with abdominal primary cancer or metastatic disease. A neurolytic celiac plexus block (CPB) would be necessary to alleviate pain and improve QoL until death. Aims: The aim of this retrospective study is to investigate pain relief after a transaortic celiac plexus neurolysis for patients with upper gastrointestinal malignancies. Settings and Design: This retrospective observational study was done in the Pain Department, Shri Siddhivinayak Cancer Hospital, Miraj from January 2005 to January 2015. Materials and Methods: One hundred and twenty-four patients with upper abdominal malignancy received a computed trans-aortic celiac plexus block (TAoCPB) on a day-care basis. The primary outcome was pain as assessed with numerical rating scale ranging from 0 to 10; the secondary outcome measures were morphine consumption per day, QoL, and complications, if any. These were recorded before intervention, on day 1 after the block and at 1 month interval until 6 months. Statistical Analysis Used: Bonferroni correction for multiple comparisons and a P < 0.0167 (0.05/3) was considered to be statistically significant due to 3 co-primary outcomes being measured (visual analog scale [VAS] scores, morphine consumption, and QoL). Results: Up to 4.5 months, the VAS score, daily morphine consumption, and the QoL showed improvement for the duration of the study. Pain gradually increased at 6 months with a deterioration of QoL. Respiratory distress and burning sensation in chest occurred in one patient each. Conclusions: A low-volume TAoCPB is effective and established procedure as a day-care procedure. Although pain relief occurs until 4.5 months, a gradual increase was perceived with a decline of quality of health at 6 months. [ABSTRACT FROM AUTHOR]

Byline: Nita. D'souza, Kirthi. Mara, Pranita. Patil, Sandeep. Diwan Paediatric regional anesthesia with ultrasound guidance is emerging as a safe, effective means to provide analgesia.[1] In comparison to adults, many [...]

Byline: Abhijit. Nair, Sandeep. Diwan Sir, Randomized controlled trial (RCT) is considered gold standard in terms of clinical research as it provides best level of evidence which is required to [...]

Byline: Sandeep. Diwan, Abhijit. Nair Sir, A 25-year-old male who sustained high-velocity injury after a road traffic accident was brought to emergency room in a hypotensive state with blood pressure [...]

Severe and persistent pain of cancer and noncancer origin in pediatric patients can pose significant challenge to manage. The application of Radiofrequency ablation in Pediatric patients for pain management is not well reported in the literature. Here, we present pediatric cases where pulsed radiofrequency (PRF) treatment of the Lumbosacral plexus was done for pain relief. [ABSTRACT FROM AUTHOR]

Byline: Sandeep. Diwan, Medha. Kulkarni, Narendra. Kulkarni, Abhijit. Nair After a quadratus lumborum (QL) block, the course of QL plane catheter is unpredictable. This case series discusses the course and [...]

We describe cases in which a preoperative computed tomography was used to guide the placement of an epidural catheter through the defect in the intervertebral foramina in patients with severe lumbar scoliosis. We demonstrate the adroitness with which epidural catheters were inserted through the intervertebral foramina. Computed tomography scan illustrates and plots the needle path creating a 3-dimensional image of the vertebral body rotation, needle trajectory, and the distance from the skin to the intervertebral foramina. Severe scoliosis is defined as a lateral curvature (Cobb's angle) of more than 50 degrees. It was proposed in severe idiopathic scoliosis that interventional pain management techniques are managed with fluoroscopic imaging or an alternative form. However, after a computed tomography evaluation of the scoliotic spine, we assumed that the intervertebral foraminal anatomy would facilitate a safe and efficient epidural needle and subsequent catheter positioning in severe scoliotic patients. [ABSTRACT FROM AUTHOR]

Background: The clinical outcomes (time to ambulation, length of stay, and home discharge) after proximal femoral nail (PFN) for proximal femoral fractures (PFF) is dependent on successful pain management. Currently, the lumbar erector spinae plane block (LESPB) is in vogue and is associated with favorable outcomes in the postoperative period. Our study aimed to evaluate whether a LESPB provided equivalent analgesia and clinical outcomes as compared to LPB in PFN for PFF. Material and Methods: We compared LPBs [L] with LESPBs [E], with 30 patients in each group, performed from June 2020 to June 2021 for PFN in PFF's. The primary outcome of this study was the average NRS pain scores over 24 hours postoperatively. Secondary outcomes included pain scores at different time points over 24 hours, opioid consumption between the groups at 24 hours postoperatively, time for request of first parenteral analgesia, quadriceps weakness and adverse events. Results: The average pain scores over 24 hours were better in the LESPB group as compared to the LPB group (p = 0.02). Further, only n = 5 (30%) of patients in the LESPB group required opioids, while n = 13 (43.333%) of patients in the LPB group required opioids. Moreover, the median time for request of first parenteral analgesia was 615 (480-975) minutes, weakness of quadriceps function occurred in 2 patients in the L group, which recovered at 3rd and 5th month, respectively, with no incidences of hemodynamic instability and respiratory complications. [ABSTRACT FROM AUTHOR]