A viral jelly ball stick stuck to a child’s tonsil: a case repor Suki Ismet, Muhamad Rafiqi Hehsan Anaesthesia Pain and Intensive Care, 2025 Ingestion of foreign bodies is a common emergency in pediatrics, but cases where foreign bodies are found adhered to the tonsils are rare. They require prompt identification and management to avoid dire consequences. This condition can lead to a spectrum of clinical presentations, ranging from asymptomatic passage to respiratory compromise. We present a case report of a 7-year-old girl who complained of persistent odynophagia in the throat region. Before that, she had taken a famous and viral jelly ball, and she only complained of pain and a sharp sensation in her throat after some time. On her initial visit to the otorhinolaryngology (ORL) clinic, nothing was found, but her symptoms persisted. So, the patient was seen again in the ORL clinic. She was planned for an examination under general anesthesia due to her being uncooperative during awake throat examination.During the examination, a fine, thin wooden splinter, about 1 cm in length, was seen stuck at the posterior inferior pole of the left tonsil. The surgeon easily removed the foreign body without much bleeding. This case report presents a unique presentation and emphasises the need for clinicians to maintain a high index of suspicion for ingestion in pediatric patients presenting with oropharyngeal symptoms. Prompt diagnosis and appropriate management strategies for foreign body cases are crucial to prevent complications such as airway obstruction or perforation.Abbreviations: FB: foreign body, IV: intravenous, ORL: otorhinolaryngology, TCI: target-controlled infusionKeywords: Airway; Case Report; Emergency; Foreign Body; TonsilCitation: Hehsan MR, Ismet S. A viral jelly ball stick stuck to a child’s tonsil: a case report. Anaesth. pain intensive care 2025;29(6):630-633. DOI: 10.35975/apic.v29i6.2488Received: June 05, 2024; Revised: May 30, 2025; Accepted: May 30, 2025
Patch versus pump: Evaluating efficacy, satisfaction level and safety of transdermal fentanyl patch versus intravenous morphine with PCA pump for acute postoperative pain in orthopedic surgery Kamaruddin Ibrahim Anaesthesia Pain and Intensive Care, 2025 Background & objective: Transdermal Fentanyl Patches (TFP) are commonly used in chronic cancer pain management. TFP offer a sustained delivery of fentanyl, due to its high lipid solubility for efficient transdermal administration. This non-invasive analgesic method is particularly advantageous for severe postoperative pain, delivering fentanyl consistently and matching morphine's effectiveness while minimizing side effects. This study was conducted to compare the effectiveness, patient satisfaction and safety of TFP versus Patient-Controlled Analgesia (PCA) IV morphine for managing acute postoperative pain in orthopedic surgery.Methodology: This retrospective study compares the effectiveness, satisfaction and safety of TFP versus intravenous (IV) Patient-Controlled Analgesia (PCA) morphine for managing acute postoperative pain in orthopedic surgery. Data from 114 patients who underwent orthopedic surgery at Hospital Universiti Sains Malaysia (HUSM), were analysed, with 51 receiving TFP and 63 receiving PCA morphine. Primary outcomes included mean pain scores and patient satisfaction, while the incidence of side effects e.g., nausea, vomiting, respiratory depression, itchiness, and hypotension, served as a secondary outcome.Results: TFP demonstrated equivalent analgesic efficacy to PCA morphine. A mixed-design repeated-measures ANOVA (Greenhouse-Geisser test) indicated no significant difference in mean pain scores between TFP and PCA morphine (P = 0.364, P > 0.05). Patient satisfaction rates were similarly high, with 96% satisfaction reported for TFP. Importantly, TFP exhibited fewer side effects, observed in 6 out of 51 patients, compared to PCA morphine, which caused side effects in 12 out of 63 patients, including one case of respiratory depression.Conclusion: TFP offers comparable efficacy and patient satisfaction in acute pain management following orthopedic surgery, amd enhanced safety with fewer reported side effects compared to PCA morphine. High patient satisfaction rates further support TFP as a viable alternative in postoperative pain management.Abbreviations: NRS: Numerical Rating Scale, PCA: Patient-Controlled Analgesia, TFP: Transdermal Fentanyl Patches, TKR: total knee replacement.Keywords: fentanyl; morphine; analgesia; efficacy; satisfaction; safetyCitation: Hehsan MR, Saufian IS, Ismet S, Zainy RHM, Shamsul Kamalrujan Hassan SK, Ibrahim K. Patch versus pump: Evaluating efficacy, satisfaction level and safety of transdermal fentanyl patch versus intravenous morphine with PCA pump for acute postoperative pain in orthopedic surgery. Anaesth. pain intensive care 2025;29(4):349-55. DOI: 10.35975/apic.v29i4.2493Received: May 31, 2024; Revised: May 26, 2025; Accepted: June 01, 2025
Locked-in syndrome post facet joint injection: a case report Muhamad Rafiqi Hehsan, Suki Ismet, Shamsul Kamalrujan Hassan, Kamaruddin Ibrahim Anaesthesia Pain and Intensive Care, 2024 Locked-in syndrome (LIS) is a neurological condition characterized by quadriplegia and anarthria with preservation of consciousness. This is a rare, but serious condition as patients with LIS are conscious and possess cognitive function, but cannot move or communicate verbally due to the paralysis of nearly all voluntary muscles in the body. We present a case of a 43-year-old lady who developed locked-in syndrome following a lumbar facet joint injection for chronic spinal pain. The patient developed a sudden onset of quadriplegia and loss of speech around 10 min after the injection. Neurological examination revealed preserved consciousness and alertness, with intact cranial nerve function. Diagnostic work-up, including neuroimaging and laboratory tests, ruled out hemorrhage or other structural lesions. We discuss the potential mechanisms underlying this unexpected complication, explore diagnostic challenges and treatment options. Despite its rarity, this case highlights the importance of careful patient selection, precise procedural technique, and prompt recognition of complications associated with interventional pain procedures.Abbreviations: ITP - immune thrombocytopenic purpura; LIS - Locked-in syndrome; SLE - systemic lupus erythematous; SIJ - sacroiliac jointKeywords: Locked-In Syndrome; Facet Joint Injection; Complication; Neurological; Case ReportCitation: Hehsan MR, Ismet S, Hassan SK, Ibrahim K. Locked-in syndrome post facet joint injection: a case reportAnaesth. pain intensive care 2024;28(5):951−954. DOI: 10.35975/apic.v28i5.2512Received: July 22, 2024; Reviewed: September 05, 2024; Accepted: September 05, 2024
Comparison of analgesic efficacy and safety of bupivacaine plus ketamine versus bupivacaine alone in rectus sheath block for midline laparotomy Shamsul Kamaruljan Hassan, Pooi Yee Thang, Wan Fadzlina Wan Muhd Shukeri, Suki Ismet Anaesthesia Pain and Intensive Care, 2023 Background & Objective: Addition of ketamine affects pain modulation through multiple mechanisms and may enhance the analgesic effect of local anesthetics in rectus sheath block (RSB). However, limited studies have evaluated the analgesic efficacy and safety of ketamine added to RSB for midline laparotomy. We aimed to evaluate the analgesic efficacy and safety of ketamine as an adjuvant to 0.25% bupivacaine in ultrasound-guided RSB following major abdominal or gynecological surgery with midline incision. Methodology: Fifty-four patients of ASA class I−II, aged 18−65 y, who underwent midline laparotomy under general anesthesia were studied. The patients were randomly allocated to two groups: ultrasound-guided RSB was performed in the control group (n = 28) with 40 ml of 0.25% bupivacaine, while in the ketamine group (n = 28) it was performed with 40 ml of 0.25% bupivacaine plus ketamine 1 mg/kg. Postoperatively, both groups received IV morphine patient-controlled analgesia. The Numeric Rating Scale (NRS) pain scores at rest and on movement were assessed at 0, 1, 12 and 24 h postoperatively. The total 24-h postoperative morphine consumption and psychomimetic side effects were recorded. Results: The mean NRS pain score on movement was significantly lower in the ketamine group at most time points compared to the control group (P < 0.05). The ketamine group had a significantly reduced total 24 h postoperative morphine consumption (14.3 ± 6.55 mg) compared to the control group (21.86 ± 15.46 mg) (P < 0.05). No psychomimetic adverse effects were reported in both groups. Conclusion: The addition of ketamine to bupivacaine in RSB resulted in effective postoperative analgesia by reducing postoperative pain scores on movement in patients who underwent midline laparotomy. Such combination also reduced postoperative morphine requirement without serious side effects. Abbreviations: ERAS - Enhanced Recovery After Surgery; LA - Local anesthetics; NRS - Numeric Rating Scale; PAC - Patient-controlled analgesia; RSB - Rectus sheath block; Key words: adjuvant; Bupivacaine; Ketamine; Laparotomy; Rectus sheath block Citation: Hassan SK, Thang PY, Wan Shukeri WFWM, Ismet S. Comparison of analgesic efficacy and safety of bupivacaine plus ketamine versus bupivacaine alone in rectus sheath block for midline laparotomy. Anaesth. pain intensive care 2023;27(2):220−226. DOI: 10.35975/apic.v27i2.2188 Received: December 21, 2022; Reviewed: January 17, 2023; Accepted: January 19, 2023
Comparison of visibility and block success between Echoplex+® and Stimuplex®-Ultraline 360° echogenic needles for ultrasound-guided supraclavicular brachial plexus block for upper limb surgery Suki Ismet, Wan Mohd Nazaruddin Wan Hassan, Mohd Zulfakar Mazlan, Laila Ab Mukmin, Soon Eu Chong, et al. Anaesthesia Pain and Intensive Care, 2021 Background: Needle visibility is an important factor in the success of ultrasound-guided peripheral nerve block. This study aimed to compare needle visibility, block performance, time to perform block and the block success by the two echogenic needles, the Echoplex+® and the Stimuplex® Ultraline 360°, during ultrasound-guided supraclavicular brachial plexus block (SBPB). Methodology: Seventy patients scheduled for upper limb surgery under SBPB were randomised into two groups: Group E (n = 35) was blocked using an Echoplex+® needle and Group S (n = 35) was blocked using a Stimuplex® Ultraline 360° needle. All patients received 20 ml of ropivacaine 0.75% using the same brand of ultrasound machine. The needle visibility, time to perform block and block success were recorded. Results: Needle visibility was not found to be significantly different between the groups (p = 0.241). The medians of the time to perform block (11.0 [IQR 6] vs. 10.0 [IQR 4] min; p = 0.278) and the percentages of adequate blocks (p = 0.565) were also not found to be statistically significantly different. Conclusion: No statistically significant differences, in terms of needle visibility, time to perform block and the block success, were found between the Echoplex+® and the Stimuplex® Ultraline 360° block needles during supraclavicular brachial plexus block. Hence, both were equally effective for the performance of the block. Key words: Echogenic needle; Visibility; Ultrasound-guided; Supraclavicular block; Brachial plexus Citation: Ismet LA, Hassan WMNW, Mazlan MZ, Mukmin LA, Chong SE, Zaini RHM. Comparison of visibility and block success between Echoplex+® and Stimuplex®-Ultraline 360○ echogenic needles for ultrasound-guided supraclavicular brachial plexus block for upper limb surgery. Anaesth. pain intensive care 2021;25(6):788–792; DOI: 10.35975/apic.v25i6.1703 Citation: July 26, 2021, Reviewed: August 02, 2021, Accepted: October 03, 2021
