https://hdl.handle.net/20.500.14356/996 2026-04-13T10:24:35Z https://hdl.handle.net/20.500.14356/1065 Title: Peripheral Nerve and Plexus Blocks for Hip Surgery in a Nonagenarian with Severe Cardiac Disease Authors: Acharya, Utsav; Shrestha, Ninadini; Lamsal, Ritesh Abstract: Abstract The hemodynamic alterations and stress response associated with anesthesia and surgery are often poorly tolerated by elderly patients. Regional anesthesia techniques are useful in the elderly as they provide excellent perioperative analgesia with minimal hemodynamic perturbations. We report the case of a 90-year-old man with valvular heart disease and severe left ventricular systolic dysfunction, who underwent dynamic hip screw fixation of fractured femur neck under combined pericapsular nerve group block, lumbar plexus block, and para-sacral sciatic nerve block. We are not aware of any previous report of the combination of these blocks used for surgical anesthesia in hip fracture surgery. Keywords: Geriatric; hip fracture; pericapsular nerve group block; regional anesthesia. Description: Case Report 2022-01-01T00:00:00Z https://hdl.handle.net/20.500.14356/1064 Title: Ultrasound Guided Nerve Blocks for Anterior Cutaneous Nerve Entrapment Syndrome an Overlooked Cause of Chronic Abdominal Pain: A Case Series Authors: Rayamajhi, Anuj Jung; Hamal, Pawan Kumar; Bhattarai, Prajjwal Raj; Paudel, Subash Chandra; Paudel, Prashanta; Dhungel, Bidur; Yadav, Rupesh Kumar; Pokhrel, Nabin; Timilsina, Sarika Abstract: Abstract Entrapment abdominal neuropathy is not a common diagnosis in our context. Chronic Abdominal wall pain is often mistaken for gastritis, gynecological issue, thoracic spinal radiculopathy, rectus sheath hematoma, abdominal muscle injury or psychiatric disorder. Anterior cutaneous nerve entrapment syndrome is one of the frequent causes of abdominal wall pain occurring due to trapped thoracic intercostal nerves between abdominal muscles. History and bedside Carnett’s sign can elicit the diagnosis. Injection of the local anesthetics with steroids in the junction between the rectus sheath and abdominal muscle under ultrasound guidance can provide sustained pain relief. We should consider Anterior cutaneous nerve entrapment syndrome as a differential diagnosis while evaluating the abdominal wall pain. Keywords: ACENE; carnett’s test; chronic abdominal pain; entrapment neuropathy; hydrodissection. Description: Case Report 2022-01-01T00:00:00Z https://hdl.handle.net/20.500.14356/1063 Title: Pleural Effusion: An Uncommon Manifestation of Hepatitis Authors: Shahi, Rejina; Bhatta, Narendra; Mishra, Deebya Raj; Acharya, Achyut Bhakta; Verma, Avatar VermaShahiR., BhattaN., MishraD. R., AcharyaA. B., & VermaA. (2022). Pleural Effusion: An Uncommon Manifestation of Hepatitis. Journal of Nepal Health Research Council, 20(01), 269-271. https://doi.org/10.33314/jnhrc.v20i01.3498 Abstract: Abstract Hepatitis A virus infection is the commonest form of hepatitis in pediatric age group and common health problem in developing countries due to poor sanitation. The clinical spectrum of hepatitis A virus infection ranges from asymptomatic infection to fulminant hepatitis and the symptoms are primarily hepatobiliary or constitutional. Here, we present a case of 16 years old male who presented with complains of fever, vomiting, anorexia, right sided abdominal pain, shortness of breath and cough. On clinical examination, patient has hepatomegaly and decreased breath sounds on right sided mammary, infra- mammary and infra scapular region. Blood investigations showed aminotransferases while pleural effusion and ascites with thickened gall bladder were found in chest x-ray and abdominal ultrasonography respectively. In absence of others causes, pleural effusion can be a rare complication of hepatitis A. Thus, this complication should be kept in mind in endemic countries in clinically matching scenarios. Keywords: Acalculous cholecystitis; ascites; hepatitis A; pleural effusion Description: Case Report 2022-01-01T00:00:00Z https://hdl.handle.net/20.500.14356/1062 Title: Hepatic Encephalopathy Induced Transient Cortical Blindness Authors: Pokhrel, Shweta; Shrestha, Pramesh Sunder; Pathak, Rahul; Bhattarai, Suju; Karki, Bipin; Paudel, Shachi Abstract: Abstract Hepatic encephalopathy describes a spectrum of potentially reversible neuropsychiatric abnormalities seen in a patient with severe liver dysfunction with porto-systemic shunting. Cortical blindness can be a rare presentation of hepatic encephalopathy and can even precede the onset of altered sensorium. We report a case of 57 years female with chronic liver disease who presented with bilateral loss of vision, with no focal neurological deficits. From clinical and laboratory examination, a diagnosis of hepatic encephalopathy with cortical blindness was proposed. Her visual disturbances gradually improved with the treatment of hepatic encephalopathy. Keywords: Cortical blindness; end stage liver disease; hepatic encephalopathy; papilledema. Description: Case Report 2022-01-01T00:00:00Z