Introduction: De Quervain's tenosynovitis is a disease with pain in the styloid process area due to chronic inflammation of the tendons covering the abductor pollicis longus and extensor pollicis brevis muscles at the level of the distal radius. This study aims to describe the treatment of de Quervain's tenosynovitis with prolotherapy. Case presentation: A woman, 49 years old, working as a cleaning service, came to the hospital with complaints of pain in her right thumb and wrist. Pain has been felt since 1.5 years ago, especially when using the hand and moving the thumb. The pain has been getting worse in the last 4 months and is sometimes swollen and red near the thumb. Physical examination showed nodules measuring 2x1 cm in the right radial region, positive tenderness, positive Allen test, active and passive movement of digit 1, rotation and adduction inhibition, wrist extension and digitorum positive, wrist flexion and digitorum positive, and a positive Finkelstein test. The patient was diagnosed with de Quervain's tenosynovitis dextra. Prolotherapy was carried out as pain management in this patient. Conclusion: Treatment with injection prolotherapy of patients with complaints of de Quervain's tenosynovitis using a mixture of D40% solution and lidocaine has a good prognosis for symptom improvement and relatively minimal complications.

Introduction: This study aims to present the management of postoperative c-section pain using multimodal analgesia. Case presentation: There were two patients who received multimodal analgesia as a treatment for postoperative C-section pain. The first patient, a woman 15 years old, will undergo a Caesarean section operation with indications G1P0A0, term pregnancy, and cephalopelvic disproportion (CPD). The second patient, a 23-year-old woman, will undergo a Caesarean section operation with indications G1P0A0, term pregnancy, and 1x umbilical cord. Physical examination of both patients showed vital signs within normal limits. Laboratory evaluation within normal limits. Both patients were included in the ASA II category. The anesthetic method used intraoperatively was subarachnoid block with hyperbaric bupivacaine 0.5% 10 mg and morphine 50 mcg. Lidocaine infiltration injection is performed intraoperatively in combination with the following; lidocaine 2% (3 ampoules), dexamethasone 4 mg, ketorolac 60 mg, and morphine 4000 mcg dissolved in aquabides into 20 ml subcutaneously. Conclusion: A multimodal analgesia is an appropriate approach for postoperative pain management in patients undergoing cesarean section.

Latar Belakang: Nyeri menjadi permasalahan yang sering dihadapi oleh wanita pascabedah seksio caesarea yang ditandai dengan meningkatnya kadar interluekin-6. Anestesi infiltrasi intraoperatif direkomendasikan pada seksio caesarea elektif sebagai manajemen nyeri.Tujuan: Menilai efek anestesi infiltrasi bupivakain isobarik 0,25% 50 mg pada luka insisi terhadap intensitas nyeri dan kadar IL-6 pada pascabedah seksio sesarea. Subjek dan Metode: Penelitian ini menggunakan pendekatan uji klinis acak tersamar ganda. Sampel terdiri atas 3 kelompok yaitu kontrol (B0), diberi anestesi infiltrasi bupivakain sebelum insisi (B1), dan diberi anestesi infiltrasi bupivakain setelah insisi dan sebelum luka ditutup (B2) dengan jumlah sampel masing-masing 8 orang. Data dianalisis menggunakan uji Anova, Kruskal Wallis dan paired t-test dengan tingkat kemaknaan α=0,05. Hasil: Skor nyeri berbeda signifikan antara kelompok anestesi infiltrasi dengan kontrol pada 8 jam pascabedah (p<0,05). Kadar interleukin-6 berbeda signifikan antara kelompok anestesi infiltrasi dengan kontrol dan antara anestesi infiltrasi sebelum dengan setelah insisi pada 4 jam pasca bedah (p<0,05). Anestesi infiltrasi sebelum insisi menurunkan kadar interleukin-6 lebih besar dibandingkan setelah insisi mulai dari 4 jam pascabedah seksio sesarea.Simpulan: Pemberian anestesi infiltrasi sebelum insisi dapat menurunkan kadar interleukin-6 lebih cepat dan lebih besar daripada setelah insisi dan juga mengurangi intensitas nyeri

Introduction: Ketamine used for patients in the intensive care unit provides a combination of sedation and analgesia as well as a beneficial effect on hemodynamics. This study aims to describe the use of continuous intravenous ketamine as postoperative laparotomy pain management in septic shock. Case presentation: A man, 55 years old, came to the emergency room with complaints of abdominal pain accompanied by bloating, nausea, and vomiting. From the anamnesis and physical examination and support, a diagnosis of peritonitis generalisata et causa hernia suspect incarceration was found. In postoperative observation, vital sign examination showed blood pressure 80/50, pulse 128x/minute, respiratory rate 24x/minute, temperature 37.7ºC, and numeric rating scale 5/10. The treatment the patient got was simple oxygen mask 6-7 L/ minutes, IVFD ringer lactate 3000 cc/24 hours, intravenous ceftriaxone 1gr/12 hours, intravenous metronidazole 500 mg/8 hours, norepinephrine 0.15-0.2 mcg/kg/minute titration, dobutamine 7.5 mcg/kg/minute titration, fentanyl 0.5 mcg/kg/hour titration, ketamine 0.08-0.1 mg/kg/hour and intravenous paracetamol drips 1gr/ 6 hours. The patient experienced improvement and decreased the need for postoperative fentanyl analgesia from 0.5 mcg to 0.3 mcg/kg/hour. Conclusion: The addition of continuous ketamine for acute pain management has been shown to reduce opioid requirements in critically ill patients. The combination of low doses of ketamine together with continuous opioids resulted in a lower pain scale and decreased cumulative use of opioids.

Background: The addition of adjuvants to local anesthetics in the peribulbar block might be a method to elevate block quality. This study aimed to determine the effectiveness of peribulbar local anesthesia adjuvants using dexmedetomidine 20 mcg and dexamethasone 5 mg. Patients and Methods: This study was a single-blind randomized clinical trial. Patients were divided into three groups who received peribulbar group: Group C (4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of normal saline), Group D (4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of dexamethasone 5 mg), and Group M (received 4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of dexmedetomidine 20 mcg). Sensory and motor block onsets and durations were assessed. Results: There were 42 patients included. The sensory block onset was 70.7 s in Group M and the slowest in Group C (152.1 s). The longest sensory block duration was found in Group D (259.3 min) and the shortest in Group C (143.2 min). Conclusion: Dexamethasone 5 mg adjuvant affected sensory block onset, sensory, and motor block duration but did not affect motor block onset, while dexmedetomidine 20 mcg adjuvant affected sensory and motor block onsets as well as sensory and motor block durations.