The addition of small dose of morphine to the spinal component of the CSE technique improved the effectiveness of epidural labour analgesia and reduced the need for pain medications over 24 h, but resulted in a small increase in nausea.

Background and Aims: Myofascial pain syndrome (MPS) is a common cause of chronic musculoskeletal pain, characterised by myofascial trigger points (TPs). TP injection is an established technique for management of MPS. In this study, we analysed the efficacy of myofascial TP injection of lignocaine and the influencing biomechanical factors on MPS. Methods: After obtaining ethical committee approval, we included the first 100 adult patients of MPS with failed physical therapy aged above 18 years, and with TPs in the trapezius, infraspinatus, and/or the levator scapulae muscles and Visual analog scale (VAS) >4. TP injection of 2% (2 ml) lignocaine was performed. Visual analogue scale (VAS) scores were recorded immediately and after 1 month. Number of repeat TP injections and use of oral analgesic in one month was noted. Results were analysed with the analysis of variance test. Results: The mean VAS reduced significantly both immediately and 1 month after therapeutic injections (8.57 ± 0.77, 2.67 ± 1.43 and 2.82 ± 1.4, respectively, P < 0.01). Keeping the palm below the head during sleep was the major contributing factor for myofascial TP, followed by slanting the neck to use mobile phones. Repeat TP injection was used in 4% of cases. Conclusion: TP injection of 2 ml of 2% lignocaine along with correction of predisposing biomechanical factors provided significant pain relief for MPS in patients with failed physical therapy without any side effects.

Background: Septoplasty is often performed under sedation with local anesthesia. Midazolam is one of the commonly used sedative but it lacks analgesic effect. Dexmedetomidine is now preferred, owing to the side effects of midazolam. However, there seems to be addressable literature void in this regard. This study was aimed to evaluate and compare the effectiveness of sedation between midazolam and dexmedetomidine infusions for procedural sedation during septoplasty under local anesthesia Patients and Methods: This was a randomized clinical trial involving sixty patients undertaking elective septoplasty under local anesthesia randomized into Group A that received intravenous dexmedetomidine 1 μg/kg over 10 min, followed by continuous infusion 0.5 μg/kg/h and Group B receiving intravenous midazolam 50 μg/kg (over 10 min), followed by continuous infusion 50 μg/kg/h. The Ramsay sedation score (RSS) and patient and surgeon satisfaction scores were documented. The analysis was done using the Chi-square test and Student t-test. Results: A significant change in the heart rate from 10 to 60 min was observed between the two groups (P < 0.05). The midazolam group showed a significant increase in mean arterial pressure (MAP) from baseline to 40 min time interval (P < 0.05). The respiratory rate remained constant in both groups. Patients attaining target RSS of 3–4 were significantly higher in the dexmedetomidine group (P < 0.05). Patient satisfaction score and surgeon satisfaction score were higher in the dexmedetomidine group (P < 0.05). Conclusion: Dexmedetomidine for septoplasty under local anesthesia is more effective than midazolam infusion in providing adequate sedation and provides stable hemodynamics and well-preserved respiratory functions.