Comparative Evaluation Of Ultrasound Guided Trigger Point Injections Versus Trapezius Plane Block In Myofascial Pain Syndrome Patients In Terms Of Pain Relief And Quality Of Life

After detailed history and clinical examination, patients will be admitted on IPD basis and written informed consent will be obtained. Patients will be asked to pick a number on the random number table and will be assigned to either Group I or Group B.

Patients will be tested for any drug reactions for Lignocaine or bupivacaine with subcutaneous injection of 0.1ml using an insulin syringe.

Patient will be instructed to be Nil Per Oral for 6 hours for solid food and 2 hours for clear liquids.

Equipments needed: Sterile gloves, Gauze, Alcohol pads, 2ml, 5ml and 10 mL Syringes, 21-25 G spinal quincke needles (used depending on location of TP and body habitus ), Adhesive bandage, Surgical Marker, 2% lidocaine, Triamcinolone 40 or 80mg and 0.25% bupivacaine.

After Checking Ambu bag, defibrillator, crash cart and airway trolley and Anesthesia machine check, Patient will be shifted to the operating room, attached with standard monitors (ECG, Non invasive BP and Peripheral oxygen Saturation probe), intravenous cannula secured and patient will be positioned in prone position

Procedure for Patient assigned into Group I : Trigger point injection:

Under aseptic conditions, parts will be painted and draped. Under ultrasound guidance, using a high frequency (10-15 mHz) linear probe, the trigger points will be visualised. After anaesthetising the skin with 1% lidocaine, 23 gauge spinal needle is used,

Using the In- plane technique, Needle will be inserted 1 to 2 cm away from the trigger point so that the needle will be advanced into the trigger point at an acute angle of 30 degrees to the skin. Once ensuring the needle is in place and confirming with negative aspiration, A total of 80 mg of Inj.

Triamcinolone and 3 to 4 ml of 0.25% Bupivacaine in each trigger point not exceeding more than 20 ml. Adhesive bandage will be applied and the patient will be asked to stretch the muscle and NRS pain scale will be assessed 5 mins after the end of the procedure.

Procedure for Patient assigned into Group B: Trapezius plane block:

Under aseptic conditions, parts will be painted and draped. Under ultrasound guidance, using high frequency (10-15 mHz) linear probe, Spinous process and transverse processes of T4 level of vertebra will be visualised by placing the linear USG probe transversely and longitudinally respectively.

Erector spinae, rhomboid major and trapezius muscles will be visualised from deep to surface. A 22 gauge Quincke needle will be inserted 2-3 cm away along the axis of the probe and advanced by an in-plane technique until it reaches the transverse process. After ensuring the needle is in place and negative aspiration, 0.25% bupivacaine with 80 mg of Triamcinolone will be injected into the interfascial plane between the erector spinae muscle and T4 transverse process, under the superficial fascial plane of trapezius muscle, about 3 to 5 cm lateral from the midline where the dorsal rami of the spinal nerves emerge. Adhesive bandage will be applied and patient will be asked to stretch the muscle and NRS pain scale will be assessed 5mins after the end of the procedure.

Quality of Life Enjoyment and Satisfaction Questionnaire – Short Form (Q-LES-Q-SF) Taking everything into consideration, during the past week how satisfied have you been with your……… Very Poor Poor Fair Good Very Good …..physical health? 1 2 3 4 5 …..mood? 1 2 3 4 5 …..work? 1 2 3 4 5 …..household activities? 1 2 3 4 5 …..social relationships? 1 2 3 4 5 …..family relationships? 1 2 3 4 5 …..leisure time activities? 1 2 3 4 5 …..ability to function in daily life? 1 2 3 4 5 …..sexual drive, interest and/or performance?* 1 2 3 4 5 …..economic status? 1 2 3 4 5 …..living/housing situation?* 1 2 3 4 5 …..ability to get around physically without feeling dizzy or unsteady or falling?* 1 2 3 4 5 …..your vision in terms of ability to do work or hobbies?* 1 2 3 4 5 …..overall sense of well being? 1 2 3 4 5 …..medication? (If not taking any, check here and leave item blank.) 1 2 3 4 5 …..How would you rate your overall life satisfaction and contentment during the past week? 1 2 3 4 5 *If satisfaction is very poor, poor or fair on these items, please UNDERLINE the factor(s) associated with a lack of satisfaction.