Indian Journal of Anesthesia and Analgesia

Background: The use of adjuncts with local anaesthetics improve the quality of sensory block and prolong the postoperative analgesia in Intravenous Regional Anaesthesia (IVRA). Material and Methods: Ninety adult American Society of Anaesthesiologists (ASA) I and II patients in the age group of 20-50 years scheduled to undergo upper limb surgery were randomly divided into three groups (n=30). Group LT received lignocaine 3mg/kg with tramadol 50 mg; Group LB patients received lignocaine 3mg/ kg with butorphanol 1mg and Group L received lignocaine 3mg/kg alone. Double tourniquet technique was used. Hemodynamic changes, onset of sensory block, need for analgesic supplement, time to first rescue analgesic requirement in the post-operative period and adverse effects were compared in the three groups. Stastical Analysis was performed using Chi-square test and students unpaired t-test. Results: The mean time of onset of analgesia was 3.35±1.24 min in Group LT, 3.5±2.4 min in Group LB and 5.5±1.23 min in Group L. Analgesic supplementation was required in 10%, 13.33% and 16.67% patients in Group LT, Group LB and Group L respectively. The mean time to first postoperative analgesic requirement was 282.5±9.84 min in Group LT, 184.50±9.25 min in Group LB and 124.5±14.25 min in Group L. Conclusion: The addition of tramadol or butorphanol to lignocaine in IVRA enhances the onset of sensory block, improves the quality of the block and provides prolonged postoperative pain relief with minimal adverse effects as compared to lignocaine alone.

Adequate myocardial oxygenation during the perioperative period is crucial for a good postoperative outcome. This requires the maintenance of myocardial oxygen supply demand ratio, which can be disrupted by various perioperative events. Normally there is a significant reserve in the myocardial oxygen supply, but it can be reduced in pathologic conditions like coronary artery disease, anemia and hypoxemia, which can result in myocardial ischemia. Though myocardial oxygenation is autoregulated over a wide range of perfusion pressures, perioperative events that affect the heart rate, myocardial contractility and coronary perfusion pressure can precipitate myocardial ischemia. Optimal outcome of these patients require good anaesthetic planning and prompt manipulation of any adverse hemodynamic events during the perioperative period.

Background: Brachial plexus blocks provide a wonderful alternative to general anaesthesia for upper limb surgeries. Various adjuvants like opioids, midazolam and 2 agonists have been used to improve the quality of block. Aim: To compare the efficacy of adding midazolam to 0.375% bupivacaine in supraclavicular technique of brachial plexus block for upper limb surgeries. Methods: 100 patients undergoing upper limb surgeries under supraclavicular block were randomized to receive 30ml of 0.375% bupivacaine Group B or 30ml of 0.375% bupivacaine with midazolam 0.05 mg/kg (Preservative free) Group BM. The onset and duration of sensory and motor block, sedation score and number of rescue analgesics needed during 24 hours post-operative period was assessed. Results: The mean time of onset of sensory and motor block was significantly faster in Group BM (11.26±1.5min, 9.56±1.32 min) than Group B (19.08±1.7min, 15.30±2.09 min) respectively. The mean duration of sensory and motor block in group BM (13.81±1.23hrs, 5.25±0.45hrs) were found to be significantly longer than in group B (5.84±0.49 hrs, 5.25±0.45 hrs). Conclusion: The addition of Midazolam as an adjuvant to bupivacaine when compared to plain bupivacaine resulted in rapid onset of sensory block and motor block, prolonged duration of sensory block, reduced number of rescue analgesics in the post-operative period of 24 hours.

Introduction: Region anaesthesia is widely used and a safe anaesthetic technique. Shivering is frequently a known complication during regional anaesthesia. Shivering is a potentially serious complication. There are various methods available to control shivering during regional anaesthesia, which include non pharmacological methods and pharmacological methods using drugs. Drugs like tramadol, clonidine, are simple, cost-effective are useful for control of shivering. Methodology: The study was conducted in Gandhi Hospital, Secunderabad. All patients who developed post–spinal anaesthesia (intraoperative) shivering were randomly allocated to two groups: Group C (n=40) received clonidine 0.5 g/kg (intravenously) IV, and group T (n=40) received tramadol 0.5 mg/kg IV. Standard monitoring of pulse rate was done, and non-invasive blood pressure (NIBP), oxygen saturation (SpO2), body temperature (axillary) were recorded before the commencement of surgery and thereafter at every 5 minutes from the baseline i.e. subarachnoid block (SAB), for 30 min; and every 15 minutes, for the rest of the observation period. Observation and Results: In the present study, we found that clonidine is as effective as tramadol in treating post–spinal anaesthesia shivering, but the time interval from the commencement of treatment to cessation of shivering is quite less with clonidine (2.54±0.76 minutes) than with tramadol (5.03±1.02 minutes) (P=.0000001). The response rate was also higher in the clonidine group than in tramadol group, but the difference was not statistically significant (P=.03). Conclusion: In conclusion, both clonidine (0.5 g/kg) and tramadol (0.5 mg/kg) effectively treated patients with post–spinal anaesthesia shivering, but tramadol took longer time to achieve complete cessation of shivering than clonidine, the difference being statistically significant. So we conclude that clonidine offers better thermodynamics than tramadol, with fewer side effects. The more frequent incidence of side effects of tramadol, like nausea, vomiting and dizziness, may limit its use as an anti-shivering drug.

One of the most common and distressing post-operative complication is post-operative nausea and vomiting (PONV). Though PONV can occur after all surgeries but it occurs more frequently among middle ear surgeries, gynecological, obstetric, ocular and breast. Ramosetron a newer 5 HT3 receptor antagonist and dexamethasone, a well known steroid both have its own anti PONV effect, but to determine their combination of therapeutic and side effects we took up this study. This randomized prospective double blinded study was conducted in our Institute. Sixty patients of ASA 1 and 2 were randomized to two groups – Group R (n=30) to receive ramosetron 0.3mg; Group R+D (n=30) to receive Ramosetron 0.3mg + Dexamethasone 8mg. Standard General Anaesthesia protocol was followed. Study drugs were administered at the time of induction. PONV was studied for period of 24hrs. Severity was assessed using PONV Score. The adverse effects were also studied. The incidence of PONV is high in ramosetron alone (R) group, compared to combination (R+D)group, where none of the patients subjected to this group showed either nausea or vomiting (0%) or any other adverse effects. Hence, we concluded that, combination of dexamethasone 8mg with ramosetron 0.3mg can be effectively employed at the time of induction to prevent PONV in patients undergoing ENT surgeries. Both ramosetron and dexamethasone are cost effective and safe for prevention of PONV.

Aims: To compare the postoperative analgesic efficacy of bupivacaine 0.125%1ml/kg versus bupivacaine 0.125% 1ml/kg and fentanyl 1 µg/kg for caudal anaesthesia in paediatric patients undergoing short surgical procedures. Settings and Design: Sixty children in the age group 1-6 years posted for routine paediatric short surgical procedures below the umbilicus were included. The data was collected in the prepared proforma consisting of age, sex, etc. meeting the objectives of the study. Patients and Methods: The 60 children were randomly divided into two groups of 30 each. Group I received 1ml/kg of 0.125% bupivacaine and Group II received 1ml/kg of 0.125% bupivacaine plus fentanyl 1µg/kg for caudal block. Postoperative analgesic efficacy was compared between two groups. Statistical Analysis: was done using students‘t’ test and chi-square test. Results: The maximum total duration of analgesia noted among both groups I and II was 510 minutes. Mean total duration of analgesia was 341.5±68.23 min in group I, whereas it was 401.5 ± 44.8 min in group II. The mean total duration of analgesia was more in group II, than in group I, which was statistically significant (p < 0.05). Conclusion: The total duration of postoperative analgesia was significantly longer in children receiving 0.125% bupivacaine 1ml/kg plus fentanyl 1µg/kg (401.5±44.89 minutes) than in children receiving 0.125% bupivacaine 1ml/kg alone. (341.5±68.23 minutes). Group II children received less number of rescue analgesics than children in Group I in 24 hours period (postoperative).

Introduction: Caesarean section under sub arachnoid block is practiced worldwide due to its advantages over generalanaesthesia. The greatest drawback is PDPH.The incidence of PDPH can be decreased by decreasing the size of the spinal needle, or by using pencil point needles, which separate rather than cut through the dural fibers. Materials and methods: 60 consecutive women of ASA I and II, aged 18- 35years, with uncomplicated pregnancy undergoing caesarian section under spinal anesthesia were recruited. They were randomly allocated to two groups of 30 patients each. Patients in group I received spinal anesthesia using 26G Quincke spinal needles and in patients of group II, 26G Whitacre needleswere used. Patients were followed up for 7 days. Observations: The incidence of PDPH was 20% in group I and 3% in group II. This difference in incidence was statistically significant (p value 0.011). In group II, 1 patient developed mild PDPH on the second postoperative day, which resolved on the 4th postop day. In group I, 6 patients developed mild PDPH on the 2nd postop day. The headache remained mild and resolved on the 4th postop day in 3 patients. Of the remaining 3 patients, 2 developed moderate headache and 1 developed severe headache on the 3rd postop day. Headache resolved on the 5th day in these 3 patients. There was a statistically significant difference in the severity of PDPH. Conclusion: The incidence of PDPH was significantly lower with 26GWhitacre needle (pencil point) when compared with 26GQuincke needle.

Introduction: Laryngoscopy and endotracheal intubation causes transient circulatory changes and are marked by tachycardia, hypertension and sometimes cardiac arrhythmias. Aims and Objective: This study was designed to compare the effectiveness of oral Gabapentin in two different doses of 800mg and 1200mg on hemodynamic response during laryngoscopy and endotracheal intubation. Method: After hospital ethics committee permission,100 patients of either sex, 18-60 years, ASA grade one, weighing 40-70 kg posted for elective surgery under general anaesthesiawere included. Group Areceived 800 mg of Gabapentin and Group B received 1200 mg of Gabapentin orally two hours prior to surgery randomly. The allocation sequence was in sealed opaque envelopes. After 90 seconds of injection Rocuronium, endotracheal intubation was performed by an anaesthetist of the level of senior resident. For each patient heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded before induction of anaesthesia, after induction of anaesthesia, immediately after endotracheal intubation at 0,1,3,5 and 10 minutes. Statistical analysis was summarized as mean and standard deviation. Results: In Group A, mean heart rate and arterial pressure increased at 0, 1, 3, 5 and 10 minutes of laryngoscopy and intubation while in Group B there was no significant change. When two groups were compared, the difference between the mean heart rate and mean arterial pressure after was statistically significant (p < 0.001). When the mean heart rate and arterial blood pressure after intubation was compared with pre induction, an increasing trend was seen in Group A at 0,1,3, 5,10 min of intubation.( p <0.001 ). In Group B, the change in the mean heart rate at 0 min after intubation was significant (p = 0.027 ) and change in the mean arterial pressure after intubation at 1 min ( p = 0.029 ) , 3 min (p = 0.021 ) and 10 min ( p = 0.014 ) was significant. Conclusion: Oral Gabapentin 1200 mg when given two hours prior to surgery was better in attenuating the pressor response to laryngoscopy and intubation as compared to oral Gabapentin 800 mg.

Background: Paediatric epidural anaesthesia and analgesia (PEA) is being accepted as a standard method of advanced pain management as epidural catheter offers the advantage of excellent long term post-operative analgesia. Aims: This prospective randomised study compares General Anaesthesia (GA) and General Anaesthesia with Paediatric Epidural Anaesthesia (GA+PEA) with regard to (i) Quality of post-operative analgesia (ii) Requirement of rescue analgesics (iii) Parental satisfaction and (iv) Complications if any. Material & Methods: 80 children of ASA status I & II (2 to 12 yrs), scheduled for elective surgeries were randomly assigned to GA or GA+PEA groups. Both the groups received routine GA. In GA+PEA group, an epidural catheter was inserted. Post-operatively, in the GA group, analgesia was facilitated with Paracetamol suppository 15mg/kg, in GA+PEA group with epidural infusion of 0.125% Bupivacaine. Pain assessment was done with CHIPPS (2 to 6 yrs) and VAS (7 to 12 yrs) scale. Rescue analgesia was supplemented if pain scale was more than 3. Parental satisfaction was assessed. Statistical Analysis: Chi-square test, student-t test and ANOVA test were used to analyse categorical, demographic and rescue analgesic requirements respectively. A p value<0.05 was considered significant. Results: The pain scores and requirement of rescue analgesics were significantly lower with p<0.001 and p=0.018 respectively in GA+PEA as compared to GA alone. The overall parental satisfaction was significantly greater in GA+PEA with p<0.001. Conclusion: GA+PEA offers advantages of improved post-operative analgesia, decreased requirement of rescue analgesics and greater parental satisfaction.

Background and Objective: Postoperative sore throat (POST) is a common complication of general anaesthesia with endotracheal intubation that affects patient satisfaction after surgery. Postoperative sore throat following tracheal intubation is due to trauma to the airway mucosa. The reported incidence of postoperative sore throat varies from 21-65%. Various pharmacological and nonpharmacological agents have been used for attenuating postoperative sore throat with variable success. Ketamine, a NMDA antagonist, is involved with antinociception and anti-inflammatory cascade with “anti-hyperalgesic’,’ anti-allodynic’ and possibly opioid ‘tolerance-protective’ effect due to an additive effect with opioids reducing wind up and central sensitization by postsynaptic NMDA blockade. Methodology: 64 patients aged between 18 to 59 years, scheduled for various elective surgical procedures undergoing endotracheal intubation belonging to ASA I-II satisfying the criteria were randomly assigned into 2 groups of 32 each. Group C: Drinking water gargle- 30ml (placebo) for 40 seconds, 5 minutes before induction. Group K: Ketamine gargle (1mL=50 mg in 29 mL drinking water) for 40 seconds, 5 minutes before induction. Results: The overall incidence of post-operative sore throat in the control group (Group C) of our study population was 96.9%. The overall incidence of post-operative sore throat was positively less in Ketamine gargle group (Group K) with 53.1% when compared to 96.9% in the control group (Group C). There was a significant decrease in the incidence of post-operative sore throat seen in the Ketamine gargle group at 4, 8 and 24 hours after extubation. Conclusion: Ketamine gargle (50 mg ketamine =1 mL in 29 mL of drinking water) for 40 seconds, 5 minutes before induction of anaesthesia is a useful adjunct to decrease post-operative sore throat after endotracheal intubation.

Background: Surgeries for hip fracture are often time consuming. Both THR and Bipolar surgeries are usually performed under spinal anaesthesia or combined spinal epidural anaesthesia. These surgeries are often accompanied by several perioperative morbidities like blood loss, post operative pain, nausea, vomiting, headache and post operative urinary retention. Aim: Aim of our study was to assess the intraoperative hemodynamic stability, blood loss, intra and postoperative analgesic requirement and intra and postoperative complications in the study groups. Materials and Methods: This study was conducted in tertiary care government hospital during the period of 2014-2016. In this prospective study after ethical committee approval, 60 patients being operated for elective hip surgeries were selected and randomly divided in two groups as Group A and Group B, 30 patients in each. All the patients were thoroughly examined, investigated and optimized for surgery. Group A Received combined spinal epidural anaesthesia. Spinal anaesthesia was given with Inj. Bupivacaine 0.5% (H) 3.5 cc+0.4 cc Normal Saline. Epidural top up was given to prolong duration of surgical anaesthesia with Inj. Bupivacaine 0.5% 4cc and for post operative analgesia with Inj. Bupivacaine 0.125% 8cc. Group B Received spinal anaesthesia with Inj. Bupivacaine 0.5%(H) 3.5cc+Inj. Clonidine 60µg. Results: In our study, Group B showed statistically significant fall in the pulse rate and blood pressure as compared to Group A (P < 0.05 statistically significant but clinically acceptable). The mean blood loss was found to be 586.6±58.6 ml in Group A while in Group B it was 495±49.7 ml( difference statistically significant.). Group A had post-operative analgesia 185±110.9 mins and in Group B it was 399.9±103.8 mins. (statistically significant). The incidence of both intraoperative and postoperative complications in both the study groups was statistically not significant. Conclusion: The results of this prospective, randomized comparative study demonstrated that addition of clonidine to spinal anaesthesia provides hypotensive anesthesia with acceptable hemodynamic parameters, with reduced blood loss, profound and prolonged postoperative pain relief. We conclude that the “spinal anaesthesia with clonidine” is a beneficial alternative for elective hip surgeries as compared to “combined spinal epidural anaesthesia”.

Background and Aim: To compare the application of betamethasone gel, lignocaine gel and KY jelly on the endotracheal tube to reduce the incidence of postoperative sore throat, cough and hoarseness of voice. Materials and Methods: With a formalapproval of our institutional ethical committee 135 patients scheduled for elective surgeries were chosen for this double blinded controlled study. They were randomized into three groups after their informed consent as betamethasone gel (Group A), lignocaine gel (Group B) and KY jelly (Group C). Postoperatively patients were quizzed about their sore throat, cough and hoarseness of voice and for any airway complications. Observation and Results: The age group of the patients in our study was between 18 and 65 years with mean age of 35.1±12.7 yrs in betamethasone group (A), 41.1±14.4 yrs in lignocaine group (B) and 39.6±15 yrs in KY jelly group (C). The incidence of sore throat was 35.6%, 71.2% and 64.4% in one hour and 31.1%, 71.2% and 60% in 24 hours for group A, B and C, respectively which was lowest in betamethasone group (A).The incidence of cough in our study was 31%,29% and 46 % in first hour and 20%,20% and 4.4% in 24 hour for group A, B & C, respectively. There were no complaints of severe cough in all 3 groups.The incidence of hoarseness of voice was found to be 34%, 40% and 22% in first hour and 7%, 38.8% and 42% in 24 hour for group A, B & C, respectively. There were no statistically significant difference noted between groups (p >0.05). Conclusion: Though postoperative cough and hoarseness of voice was present in all the groups but the severity of cough and hoarseness of voice was less in betamethasone group.

Background: Analgesia is an important concern in the post operative period in terms of complications like delayed mobility, respiratory distress and thromboembolic events. There have been a number of approaches for post operative analgesia in open appendectomy surgeries like Patient Controlled Analgesia (PCA), narcotics, NSAIDS, blocks, etc with certain limitations of each. Amongst these entire methods transversus abdominis plane (TAP) block is recently highlighted in terms of reduction in verbal numerical rating scale (VNRS) and opioids consumption. Aims: Verbal numerical rating scale (VNRS) at resting and VNRS at coughing, total opioids consumption, post operative time at which first rescue analgesia needed. Setting and Design: It is a randomized double blind controlled study. Sixty [60] adult patients included in this study of ASA grade I/II undergoing open appendectomy under general anaesthesia. Methods and Material: Patients were allocated in two groups of, TAP block group and control group. Each group has 30 patients. Patients received TAP block under USG guidance with inj. Levobupivacaine 0.5% 20ml, while Control group patients received standard care. Statistical Design: Statistical analysis was performed with the SPSS software, Trial version 23 for Windows statistical software package (SPSS inc., Chicago, USA) and Primer. Result: In our study we found that the requirement for first rescue analgesia was prolonged in TAP group 312 min v/s 76.80 min in control group, with highly significant p value (pï‚£0.001). Total tramadol doses requirement in twenty four hour in number was also reduced in TAP group which was 2.88±0.726 but 4.48±0, 51 in control group and VNRS score of patients receiving TAP block was less than patients of control group. Conclusion: Ultrasound guided TAP blocks with 20ml 0.5% levobupivacaine is superior in providing post operative analgesia than the control group.

Background and Aim: The Laryngeal mask airway (LMA) is widely used for elective short surgical procedures with both spontaneous and controlled ventilation. Brain’s standard technique of insertion is reliable but not always successful. The rotational technique has been proposed to overcome some difficulties posed by the standard technique. The aim of this study is to compare the rotational technique with the standard technique in terms of number of attempts, time taken for insertion, presence of leak, and incidence of complications like trauma, hypoxemia and laryngospasm. Methodology: 88 ASA I and II patients were randomly allocated into two groups, Group R and Group S. Anaesthesia was induced with Inj. Propofol and after jaw relaxation and absence of response to jaw thrust, LMA was inserted by the rotational technique in Group R and the standard technique in Group S. Successful placement was confirmed by chest expansion and a square wave capnographic tracing. The number of attempts, time taken for successful insertion and presence of leak were recorded. Trauma was assessed by blood stained LMA on removal. Results: The first attempt success rate was 93.2% in the standard group and 84.1% in the rotational group, the difference being statistically significant. The mean time taken for successful insertion in the standard and rotational group was not statistically significant. The rotational technique resulted in fewer leaks than the standard technique (No leak in 47% vs. 31.8%). The incidence of trauma was significantly less in the rotational group (11.4% Vs 18.2). Conclusion: The incidence of leak around the cuff and trauma were significantly less in the rotational technique.

Context: The assessment of the efficacy of low dose (30 micrograms) of dexmeditomedine added to 0.25% bupivacaine was studied for the prolongation of the duration of sensory and motor block in supraclavicular brachial plexus block was the aim of our study. Methods: This was a prospective double blind randomized study conducted on sixty patients posted for upper limb surgeries between the age group of 18 to 60 years, the patients were randomly allocated to two groups of 30 each. The control group (C) received 37 ml of 0.25% bupivacaine with 3 ml of normal saline; while the study group (S) received 37 ml of 0.25% bupivacaine with 3 ml of normal saline containing 30 micrograms of dexmeditomedine. Assesment of sensory and motor block was done with the monitoring of heart rate, blood pressure and peripheral oxygen saturation throughout the procedure and postoperatively till the waning of block effect. The duration of analgesia and occurance of various side effects was noted. Results: It was observed that the onset time for sensory and motor block was similar in both the groups. The duration of sensory and motor block and post operative analgesia was longer in the study group and was statistically significant. Adverse effects like bradycardia, hypotension, nausea and vomiting were insignificant occurred in one or two cases. Conclusion: Dexmeditomedine in the doses of 30 µg added to bupivacaine as an adjuvant prolongs the duration of sensory and motor block with no significant side effects.

The insertion of the epidural catheter at the thoracic spine is technically more difficult and can cause neurological complications. The ultrasound prepuncture knowledge of the distance from the skin to the extradural space and a preview of the spinal anatomy may facilitate the procedure. Hence the aim of our study was to evaluate the accuracy of ultrasound in prediction of the depth for thoracic epidural insertion using paramedian approach. Aims and Objectives: To compare the depth of thoracic epidural space as measured by US compared to the actual depth of space by loss of resistance. Material Method: Thirty four patients, age  20 years undergoing any major surgery, requiring thoracic epidural for intraoperative and postoperative pain relief belonging to ASA 1-4 status were selected. The approval of research ethical committee of the institution was obtained. The written informed consent of patients were taken after explaining the procedure and the aim of the study in detail. The thoracic spine of these patients were scanned preoperatively with ultrasound in sitting position. The probe was placed vertically in the paramedian plane and the skin epidural depth was noted. After infiltrating the skin with 3 ml of 2% lignocaine, puncture was done. The actual depth of the space by loss of resistance was noted.The analysis of the data was done using paired ‘t test’, pearson correlation co-efficient and Bland- Altman analysis. Result: Both techniques differ in their measurements. Conclusion: Pre-puncture ultrasonography does not provide accurate assessment of depth of thoracic epidural space.

Introduction: Ventilator Associated Pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICUs). The impaired host defenses and continuous exposure of the lower respiratory tract to large number of

pathogens through the endotracheal tube makes the mechanically ventilated patient prone to developing VAP. Thus present study was planned to compare the incidence of VAP in neurosurgical patients with continuous subglottic suction and conventional intermittent oral suction. Material and methods: A total of 70 adult neurosurgical patients who were expected to require mechanical ventilation for more than 72 hours were enrolled in this prospective study. These patients were randomized into two groups of 35 each. In group 1 patient were intubated with the conventional endotracheal tube and intermittent oral suction was done every 4 hourly and as and when required in addition. In group 2 the patients were intubated with Evac tube and continuous suctioning was done by maintaining a negative pressure of 20- 25 mm Hg. Both the groups were compared for the incidence of VAP. Results: Both the groups were comparable with regard to age and sex distribution. The incidence of VAP was 17.1% in patients of control group and 11.4% in patients of study group. There was an overall reduction in the incidence of VAP by 5.7% by the use of continuous subglottic suction the reduction. Conclusion: As the result shows 5.7% better outcome in study group as compared to control group, therefore the intervention used in the study group i.e. continuous subglottic suction is better than that used in control group i.e. intermittent oral suction.

Background: Both magnesium and clonidine are known to inhibit catecholamine and vasopressin release and attenuate hemodynamic response to peumoperitoneum. This randomized, double blinded, placebo controlled study was designed to assess which agent attenuates hemodynamic stress response to pneumoperitoneumin a better way. Materials and Methods: 60 patients undergoing elective laparoscopic cholecystectomy were randomized into 2 groups of 30 each. Group M patients received 50 mg/kg of magnesium sulfate in normal saline (total volume 50 ml) over 15 minutes and group C patients received 1.5g/kg clonidine in 50 ml of normal saline (total volume 50 ml) before pneumoperitoneum. Blood pressure and heart rate were recorded before induction (baseline value), at the end of infusions and every 5 minutes after pneumoperitoneum. Statistical Analysis: Chi- Square test was used for categorical data and ANOVA for inter-group comparison. Results: Intravenous administration of clonidine 1.5g/kg before pneumoperitoneumwas as effective as intravenous magnesium sulfate 50mg/kg before pneumoperitoneum in blunting the haemodynamic stress responses during laparoscopic surgeries and clonidine has lesser sedation than magnesium at extubation.

Background: The conventional technique of interscalene brachial plexus block being a blind technique may be associated with higher failure rates and injury to nerves and vascular structures. Ultrasound (US) visualization of anatomical structure is only method offering safe blocks of superior quality by optimal needle positioning. Objectives: To compare the success rate, time taken for the procedure, onset time, duration of blockade and complications of the conventional approach of interscalene brachial plexus block performed versus US guided route.

Introduction: It is difficult to compare the pain induced by different surgical modalities because pain is a subjective sensation that is highly dependent on the patient’s emotional state and cultural background. In the present study, we compared the pain between patients who had phacoemulsification with topical anaesthesia and patients who had phacoemulsification with peribulbar anesthetic infiltration. Materials & Methods: Total of 50 patients who were planned to undergo cataract surgery was included in the study. They were divided into two groups 25 in group A and 25 in group B. Group A patients received Peribulbar anaesthesia were as patients in group B received topical anaesthesia. Results: Five patients in the topical anaesthesia group required additional eyedrops during surgery for discomfort. No patient in the topical anaesthesia group required conversion to peribulbar anaesthesia. Patients in the Peribulbar anaesthesia group reported significantly greater pain than patients in the topical anaesthesia group (P = 0.0056, Mann-Whitney). Discussion & Conclusion: Topical anaesthesia is a simple, safe, atraumatic technique. Its benefits are numerous. The speed and ease of administering topical anaesthesia coupled with the rapid visual recovery after surgery makes this method a suitable and safe choice. It can be proposed as a good alternative to peribulbar or retrobulbar anaesthesia and is likely to become the preferred type of anaesthesia.

Introduction: In the present-day practice of Anaesthesiology Bupivacaine is the most commonly used drug for subarachnoid block. Many adjuvants have been tried to improve the quality of analgesia and to prolong the duration of action. The present study was conducted to assess the efficacy between dexmedetomedine versus Fentanyl as an adjuvant to Bupivacaine in lower abdominal and lower limb surgeries. Methods: 60 patients of ASA gr I and II aged between 18-60 years undergoing elective lower abdominal, urologic, lower limb surgeries were selected and divided into two groups of 30 each. Group “BP” received intrathecally 12.5mg 0.5% of Bupivacaine + 5 µg of dexmeditomedine while group “BF” received 0.5% Bupivacaine +12.5µg of Fentanyl. Onset of sensory and motor block, highest level of sensory blockade, duration of analgesia was assessed. Result: The onset of Sensory and motor blockade was same in both the groups. Duration of sensory block and analgesia was significantly prolonged in Dexmeditomedine group. So also, was the duration of motor block. Conclusion: Dexmeditomedine potentiates Bupivacaine spinal anaesthesia more than Fentanyl.

Background: The dexmedetomidine is a highly selective -2 adrenoreceptor agonist and frequently used as an adjuvant to anesthesia for intraoperative hemodynamic stability with infusion doses ranging from 0.2 to 0.7 µg/kg/hr. We have contemplated to study different infusion doses in patients undergoing supratentorial tumor surgery to establish the optimum dose. Methods: Sixty ASA grades I/II patients, aged 20-65 years scheduled for elective surgery were divided randomly into four equal groups (n=15). In groups (2, 3 & 4), dexmedetomidine was infused as a bolus dose of 1 µg/kg over15min after the induction of anesthesia; and was maintained with dexmedetomidine 0.3 µg/kg/ hr (group 2), dexmedetomidine 0.4 µg/kg/hr (group 3) and dexmedetomidine 0.5 µg/kg/ hr (group 4) as a continuous intravenous infusion at the rate of 14ml/hr during perioperative period. Group 1 received normal saline during intraoperative period. Hemodynamic changes, intraoperative brain condition, emergence characteristics and complications during the study period were assessed. Results: Heart rate, systolic, diastolic and mean arterial pressures were significantly lower in dexmedetomidine (group 2, 3 and 4) as compared to control (group 1) (p<0.05). These parameters were comparable in dexmedetomidine groups. Blunting of tachycardia response to intubation and the hypertensive response to extubation were observed in these patients. Intra-operative brain relaxation scores as assessed by surgeons were comparable in all four groups (p>0.05). Opioid sparing effect was seen with dexmedetomidine groups in terms of better hemodynamic stability even at lower doses. Incidence of bradycardia was 13% and hypotension was 20% which were higher in Group 4 but incidence was statistically comparable with other groups. Similarly, 3(20%) patients could not be extubated due to poor cough reflex and sedation. They were shifted to ICU for elective ventilation. Conclusions: Dexmedetomidine attenuates stress responses to various noxious stimuli during surgery, maintains hemodynamic stability, blunts tachycardia and hypertensive response, reduces requirements of opioids and provide good intraoperative brain conditions and early recovery. The benefit risk assessment favors an initial bolus of 1µg/ kg over 15 min followed by an infusion of 0.4 µg/kg/hr over other doses (0.3 µg/ kg/hr and 0.5 µg/kg/hr) in patients undergoing supratentorial tumor surgery.

Aims: The aim of this study was to evaluate and compare the efficacy and safety of fentanyl and midazolam given intrathecally with hyperbaric 0.5% bupivacaine in patients undergoing elective caesarean sections. Materials and Methods: A total of 180 women undergoing elective cesarean section were included in a prospective, double-blind, controlled trial. Patients were divided in three groups of 60 each and randomly assigned to receive spinal anesthesia with 2 mL 0.5% hyperbaric bupivacaine with 0.4ml of normal saline ( Group C) , 2 mL 0.5% hyperbaric bupivacaine with 12.5 g fentanyl (Group F) and 2 mL 0.5% hyperbaric bupivacaine with 2mg midazolam (Group M). Each group had a total volume of 2.4ml made by addition of normal saline. Onset and duration of sensory and motor block, duration of postoperative analgesia, hemodynamic effects and adverse effects due to study drugs were recorded and Statistical analysis was done. Results: Duration of analgesia was significantly prolonged in fentanyl group (254.83±14.84 mins.) compared to midazolam group(211.16±15.02 mins) and bupivacaine group (143.16±13.08 mins.) Hemodynamic parameters were comparable in the three groups. Side effects in all three groups were minimal. Apgar score did not differ in 3 groups. Conclusion: 12.5 g fentanyl seems to be a better alternative to 2 mg midazolam as an adjuvant to bupivacaine in patients undergoing elective cesarean section as it prolongs the duration of analgesia without any deleterious effects on the mother and baby.

Background and Aims: Intraperitoneal instillation of local anaesthetics is one of the recent techniques to minimize post-operative pain after laparoscopic surgeries. We compared the effects of intraperitoneal instillation of ropivacaine dexmedetomidine combination with that of intraperitoneal ropivacaine alone in patients undergoing laparoscopic cholecystectomies. Methods: A total of 120 patients participated in this prospective, randomized, doubleblinded study. Patients were divided into two study groups(n=60) randomly and received intraperitoneal instillation of ropivacaine (0.25%) 50 ml in Group R and ropivacaine with dexmedetomidine 1 g/kg, (diluted to 50ml volume with normal saline) in Group RD at the end of surgery under sterile precautions. Visual analogue scale score (VAS) was used to assess the quality of analgesia at various intervals. Time to the first demand for analgesia, total dose of analgesic used in the first 24 hours and adverse effects if present were noted. Statistical analysis was performed with the Student’s t-test and Chi-square test (level of significance P = 0.05). Results: VAS pain scores at different time intervals was significantly lower, time to first demand analgesia (min) in the post-operative period was increased and total post-operative analgesic consumption (mg) was lesser in group RD than group R. Also, mean heart rate and mean blood pressure were significantly lower in group RD than in group R. There was no statistically significant difference regarding the adverse effects between the groups. Conclusion: End operative intraperitoneal instillation of ropivacaine dexmedetomidine combination is superior to ropivacaine (alone) for post-operative analgesia in laparoscopic cholecystectomy.

Context: Effective postoperative analgesia is always a challenge. Drug therapies in vogue have their own merits and demerits. Thus a concept of preemptive analgesia has evolved. Aims: The present study was aimed to evaluate the efficacy of preemptive intravenous magnesium sulphate on post operative analgesia for surgeries done under general anaesthesia. Settings and Design: A prospective randomized double blind study. Methods and Material: Sixty patients of ASA grade I or II between 20 to 50 years age, of either gender were divided into two groups of 30 each. Group I received 40 mg/kg of intravenous infusion of magnesium sulphate preoperatively and 10 mg/kg/hr intraoperatively and Group II received same volume of normal saline preoperatively and intraoperatively. Statistical analysis used: Observations were analysed using‘students unpaired t-test’. Results: The pain score, sedation score at recovery and number of rescue analgesics required in 24 hours was observed. The decrease in pain scores and the higher level of sedation in group I was statistically significant (p<0.05). Conclusions: Preemptive magnesium sulphate significantly reduces postoperative pain, provides sedation and reduces analgesic requirement

Aims: To indentify airway abnormalities, autonomic nervous system dysfunction (ANSD) and postoperative respiratory complications in patients with craniovertebral junction (CVJ) anomalies with Arnold Chiari Malformation( ACM) for safe and better anaesthetic management. Method: Forty Three patients with CVJ anomalies with ACM were evaluated and operated under general anaesthesia. Result Out of 43 patients of CVJ anomalies with ACM, 29 patients had type I ACM and 14 patients had type II ACM. Vocal cord involvement was seen in three patients in type II. One patient had bilateral vocal cord paralysis (VCP), requiring tracheostomy preoperatively and one had unilateral (left) vocal cord paralysis and another one patient had bilateral vocal cord paresis. Both were planned for awake fiberoptic intubation. Overall vocal cord involvement was 6.9% with 21.42% in type II ACM. No patients had vocal cord involvement in type I ACM. In type II ACM patients, out of eight sleep apnoea patients, three had sleep apnoea with vocal cord involvement and remaining five had sleep apnoea only. Out of those five patients, three patients had difficult intubation. One patient had post operative respiratory failure requiring ventilator support for two days. Sleep apnoea was seen in 18.6% patients. All patients were belonging to type II ACM with 57.14% incidence. Syringomyelia was found in six patients with four in type I and two in type II ACM. Incidence of syringomyelia in all ACM patients was 13.95 % with 6.89% in type II and 28.5% in type I ACM. Three patients had hydrocephalus in type II ACM. Five patients with cervical collor were planned for awake fiberoptic intubation. Coclusion: Preoperative detection of airway abnormality, autonomic nervous system dysfunction , airway security using fiberoptic intubation and post operative airway protection are required for safe anaesthetic management of these patients with CVJ anomalies with ACM.

Aim: To prove the effectiveness of ketorolac as an adjuvant in intravenous regional anaesthesia. To know the effect of ketorolac on the tourniquet pain & post operative analgesia in IVRA. Materials and Methods: This is a prospective double blinded study conducted at Government Rajaji Hospital attached to Madurai Medical College. After approval by the ethical committee 50 patients of ASA grade I & II age between 20-70 years who came for upper limb surgeries which lasting for less than 60 minutes were included in this study. Patients with history of allergic to local anaesthetics, sickle cell disease, raynaud’s disease, scleroderma, local infection, pagets disease and patients with inadequate starvation <6 hours and patients who had contraindication to ketorolac were excluded from this study. Results: A (lignocaine only) and group B (lignocaine with ketorolac) patients were comparable in respect of age, sex, weight and duration of surgery. The onset of sensory blockade was similar in both the groups. But there was rapid onset of motor blockade in ketorolac group in this study. 24% patients (6 patients out of 25 patietns) need supplementation due to tourniquet pain compared to 64% patients (16 patients out of 25 patients) in the control group. The incidence of tourniquet pain in the ketorolac group was less and which statistically significant. The duration of sensory blockade after cuff deflation in study group and control group were 5.28+/- 5.34 miutes and 4.4+/- 2.44 minutes respectively. The duration of motor blockade after cuff deflation in study group and control group were 9.04+/-6.1 minutes and 7.6+/- 3.1 minutes. Though the duration of blockade found to be superior than that of control group, the difference in the effects between them were not statistically significant. The time for first analgesic requirement in study group and control group were 123.1+/-49.4 miutes and 19.4+/-11 miutes respectively. The differences between them were statistically significant. The lowest duration achieved in ketorolac group was 85 minutes and longest duration was 156 minutes. The difference between the group with respect to mean arterial pressure and pulse rate at 1minute and at 5 minutes was not statistically significant. Hence the groups were comparable with respect to mean arterial pressure and pulse rate at 1 minute and at 5 minutes after cuff deflation. There were no side effects noted in both the groups after cuff deflation. Conclusion: Ketorolac 20 mg which was added to lignocaine for IVRA provides less incidence of tourniquet pain, increases the duration of post operative analgesia and no significant increase in side effects and there was no haemodynamic changes.

Introduction: Anaesthesia for caesarean section in patients with eclampsia has always been a task of challenge. Regional anaesthesia has gained popularity in management of such cases in last few years as it avoids the problems associated with general anaesthesia. The present study aims at studying the effects of spinal anaesthesia in stable eclampsia patients. Material and Methods: Fifty pregnant patients with history of eclampsia without any complications posted for emergency caesarean section were included in the study. All of them received spinal anaesthesia with injection Bupivaciaine (0.5% heavy) 1.8 ml and 25 mcg fentanyl. All the patients were studied with respect to any hemodynamic variations intra-operatively, episodes of convulsions, need for conversion to general anaesthesia and any post operative complications. Results: Only five patients had episodes of hypotension intra-operatively and one patient had post-operative convulsion. None of them had any significant postoperative complication or need for ICU admission. Conclusion: Spinal anaesthesia can be safely used in patients with stable eclampsia for caesarean section.

Not Provided. 

Introduction: Apert syndrome is a type of acrocephalosyndactilia that includes several abnormalities. Number of coexisting conditions should be taken under consideration while giving anaesthesia. We report our experience in the anaesthetic management of case of Apert syndrome, referred to us for syndactyly release in both upper limbs. Case Report: A 13months male child with Apert syndrome, weighing 7.29 kg, scheduled for syndactyly release of both upper limbs (fusion of digit 2 to 4), had facial dysmorphism with macroglossia, craniosynostosis, short nose with widely depressed nasal bridge with bulbous tip, proptosis, wide set eyes, mandibular retraction, shield chest deformity (pectus excavatum), limited mouth opening (M.P. grading III), high arched palate, history of sleep apnoea, patent foramen ovale with left to right shunt, brachycephaly and mild ventriculomegaly. Anaesthetic Management: Case was managed under general anaesthesia with intubation in spontaneously breathing anaesthetised patient without neuromuscular blocking agents. Awake extubation was done with no intraoperative or postoperative complications. Discussion: Anaesthetic management of a patient with Apert syndrome may be challenging. The anaesthesiologist must be ready for airway problems, intubation difficulties, obtaining a good mask seal, difficult IV access. Raised intra cranial pressure, sleep apnea, possibility of mental retardation and other associated anomalies should always be considered. Conclusion: Ever vigilant Anesthesiologist who has armoured himself with all the potential problems likely to arise, in the management of children with this rare genetic syndrome (who may need repetitive surgeries), will make all the difference in the successful outcome of these patients.

Background: Supraclavicular brachial plexus block is a popular technique of anaesthesia for surgeries on upper limb. It is safe and effective & offers analgesia postoperatively. Certain group of drugs may be used as adjuvants to local anaesthetics to decrease the local anaesthetics doses and enhances the efficacy of analgesia while reducing the incidence of adverse reactions. This study was conducted to assess the effect of addition of Dexmedetomidine to a mixture of local anaesthetics for brachial plexus blockade in adult patients posted for elective upper limb orthopedic surgeries. Objective: To study the effect of addition of 50µg of Inj. Dexmedetomidine as an adjuvant to a mixture of 2% Lidocaine with adrenaline (1:200000) 15 ml + 0.5% Bupivacaine 15ml on time of onset, time for maximum effect, duration of sensory and motor blockade, duration of postoperative analgesia and to note perioperative haemodynamics and sedation scores. Methods: 60 patients of either gender in the age group of 20–60 years posted for elective upper limb surgeries were selected for the study. Patients were randomly divided into two groups (n = 30). Control Group C (n=30) received Inj. Lidocaine with adrenaline (1:2, 00,000) 2% = 15ml + Inj. Bupivacaine (0.5%) = 15ml + Inj. Sterile water = 5ml. Total volume = 35ml. The study GroupD (n=30) received Inj. Lidocaine with adrenaline (1:2, 00,000) 15ml+ Inj. Bupivacaine (0.5%) = 15ml + Inj. Dexmedetomidine 50µg (0.5 ml diluted to 5 ml sterile water= 5ml). Total volume = 35ml. They were compared for onset and duration of motor and sensory block and the duration of postoperative analgesia. Results: Onset of sensory block: Group D: 1.73 ± 0.9min vs Group C: 6.0 ± 1.8min (p<0.001). Onset of motor block: Group D: 2.8 ± 1.0min vs Group C: 8.5 ± 2.4 min (p<0.001). Duration of sensory block: Group D: 622 ± 166.4min vs Group C: 240.6 ± 63.02min (p<0.001). Duration of motor effect: Group D: 450 ± 136.2min vs group C (191.3 ± 48.9) min (p<0.001). Duration of analgesia: Group D: 1163.3 ± 334.6 min vs Group C: 351.3 ± 83.9min (p<0.001). Conclusion: As an adjuvant Inj. Dexmedetomidine, when added to local anaesthetics a) Shortens the time of onset of block, b) Prolongs the duration of sensory and motor block, c) Prolongs the duration of postoperative analgesia with better hemodynamic stability both intra operatively and post operatively.

Fiberoptic intubation (FOI) is recommended for patients with anticipated difficult airway, failed intubation, unstable cervical spine injurywhere optimum positioning for laryngoscopy is difficult to achieve. Fentany l, an opioid, is useful for fiberoptic intubation as it ensures mild sedation and analgesia with stable hemodynamics. Dexmedetomidine acts on presynaptic alpha2 receptors and results in sedation, hypnosis, amnesia, analgesia, anxiolysis, sympatholysis and antisialogogue. Aims: To compare the efficacy of Dexmedetomidine and Fentanyl as adjuvant to Propofol on intubating conditions during fiberoptic intubation. Materials and Methods: An observational, prospective clinical study was carried out on 60 patients of ASA grade I and II of either sex, aged 2060 yrs undergoing surgeries under general anaesthesia. Patients were allocated into two groups Group DD exmedetomidine group (n = 30) and Group FFentanyl group (n = 30). Intubation condition, post intubation score, depth of sedation, intubation time, any episode of hypoxia and hemodynamic changes were documented. Results: Satisfying intubation condition was procured in 27 subjects in group D as compared to 4 subjects in group F. Recommended postintubation score (= 1) was acquired in 23 Group D subjects in contrast to 3 Group F subjects. In group D, Ramsay sedation score obtained following conclusion of study drug infusion was notably high (3.230.352) as compared to Group F (2.020.262). Remarkable desaturation (SpO2 £ 94%) were encountered in 4 Group D subjects and 24 Group F subjects. Hemodynamic stability was also found more in group D. Conclusion: Dexmedetomidine by imparting superior intubation condition, stable hemodynamic parameters and appropriate sedation without desaturation is more efficacious as compared to Fentanyl when used for FOI. 

Background: Postoperative pain management in TKR is of imperative importance. Epidural analgesia though considered as a standard technique in postoperative pain management in TKR it was commonly associated with unwanted side effects such as hypotension and urinary retention. FNB is also a common method of analgesia which is a much easier technique to master and has a very low risk of side effects. Aim: To compare the efficacy between continuous epidural analgesia and continuous femoral nerve block for postoperative pain relief in Total knee replacement surgeries. Methodology: The study was conducted by the department of anaesthesiology of Vinayaka Misssions Kirupananda Variyar Medical College and Hospital,salem for a period of 1 year between Jan 2016–Dec 2016. A total of 60 patients were included in our study. 30 patients received continuous femoral nerve block and 30 patients received continuous epidural analgesia. The patient’s pain assessment was done by visual analogue scale and Wong baker faces pain rating scale. Pain assessment was done every 4th hour for 48 hours. Patients were also monitored for any incidence of side effects. Results: Among the patients who had received femoral nerve block the visual analogue pain score ranged between 0 and 2, whereas among the patients who had received epidural analgesia the score ranged between 2 and 4. There was a statistically significant difference in the pain perception between the two groups and a similar type of pain perception was also seen with Wong baker faces pain rating scale. Epidural analgesia group of patients experienced higher incidence of side effects like urinary retention, nausea, vomiting and hypotension compared to femoral nerve block and the difference was found to be statistically significant. Conclusion: Continuous femoral nerve block can be recommended as an effective alternative to epidural analgesia for postoperative pain management in TKR.

Keywords: Epidural Analgesia; Femoral Nerve Block; Pain Rating Scale; Side Effects. 

Context: Potentiating of the effects of intrathecal Local anesthetics by addition of Opioids for intraabdominal surgeries is a well established fact. Aims: To study effects of low dose fentanyl (12.5mcg) on the spinal block characteristics, quality of intraoperative surgical anesthesia and requirement of rescue analgesia in immediate post period. Settings and Design: A prospective,randomized,controlled study undertaken at Jawaharlal Nehru Medical College, Wardha during January 2014January 2015. Methods and Material: Ninety full term parturients posted for elective Cesarian Section were included after written informed consent. These 90 parturients were divided into two groups of 45 each, Group BF and Group BC. Group BF received intrathecal 2cc of 0.5% hyperbaric Bupivacaine + 0.25cc (12.5mcg) of preservative free Fentanyl (Total volume 2.25cc). Vital signs at every 2 minutes for first 10 minnutes, at 15 minutes for first 1hour and thereafter at 30 minutes interval until the patient complains of pain, sensory and motor block characteristics with side effects were observed throughout. Statistical Analysis Used: Means and SD, unpaired t test. Results: Time of onset of sensory analgesia was rapid in Fentanyl (BF) group than only Bupivacaine (BC) group [1.9±056 vs 2.46±079]. Two segment regression time group [129.11±31.26 vs 99.78±17.69], Complete sensory recovery [277.2±33.3 vs 185.0±29.8]and Total duration of effective analgesia [259.4±35.3 vs 165.0±29.8] were prolonged in BF and statistically significant as compared with BC group. Total duration of Grade III motor block was also significantly prolonged in BF group [137±33.4 vs 119±18.5]. However, incidence of side effects and APGAR scores were comparable in both the groups. Conclusions: Low dose intrathecal fentanyl markedly improves introperative analgesia, with insignificant hemodynamic effects significantly reduces the demand of analgesics in immediate postoperative period, therefore provides great maternal satisfaction and equal APGAR score in both groups compared.

Context: Dexmedetomidine has been a prime matter of subject studies in research over it with its comparison with various other agents as it possesses properties like sedation and analgesia. Aims: To study the effectiveness of dexmedetomidine in intravenous regional anesthesia. Settings and Design: This is a prospective, randomized, double blind control study conducted at SVS Hospital and Medical College, Mahabubnagar. Methods and Material: In this study totally 60 patients were divided into two groups. We gave 40 ml of Lignocaine with 0.5 microgram/kg Dexmedetomidine in Group LD patients. 40 ml of 0.5% Lignocaine was given for Group L patients. Statistical Analysis: Mean and standard deviation were calculated. Student’s t test was used for statistical analysis. P value of less than 0.05 was taken as statistically significant. Results: Both the groups were comparable in terms of pulse rate, age, duration of surgery, weight, and mean arterial blood pressure. Sensory onset time, motor onset time was significantly lesser in LD group compared to L group. At the same time, motor recovery time and sensory recovery time were significantly more in LD group compared to L group (p<0.05). Duration of post operative analgesia when VAS was more than 3 was significantly more in LD group compared to L group (p<0.05). Conclusion: Dexmedetomidine was found to be very effective in terms of less occurrence of pain of tourniquet, quick onset of motor and sensory blockade, hemodynamic stability, persistence of analgesia post operatively.

Introduction: Spinal anaesthesia represents an attractive proposition for daycase anaesthesia, being associated with less postoperative nausea and vomiting (PONV) and better postoperative pain relief than general anaesthesia. However, significant concerns restrict the more widespread use of spinal anaesthesia for daycase procedures: the risk of PDPH (post dural puncture headache); the effect on bladder function; and delay in recovery of motor function. Methodology: This study was conducted on 60 patients between the age group of 18 to 60 years, of either sex, belonging to ASA grade I & II who were posted for elective lower abdominal, urological surgeries under spinal anesthesia .Only those patients were selected for the study from whom informed consent was obtained. Results: The time taken to achieve maximum sensory block in DB group was 5.20 minutes compared to 6.07 of PB group. In this regard the DB group is faster than PB group and this difference in attaining sensory block was statistically significant.The time taken to achieve maximum motor block in DB group was 5.57 minutes compared to 6.23 of PB group. In this regard the DB group is faster than PB group and this difference in attaining motor block was statistically significant. Conclusion: DB group is faster than PB group and this difference in attaining motor block was statistically significant.

 Context: Even though the branch of anaesthesia is very crucial in hospital, managing acute care, most of the people are unaware of the role played by anaesthesiologist. The unfamiliarity is more in patients belonging to low socio economic groups, which may sometimes lead to medico legal issues. Aims: We have conducted a survey, to evaluate the level of knowledge about the speciality anaesthesia and significance of preanaesthetic checkup in patients belonging to low socio economic group. Settings and Design: The study was done in a public sector hospital, by circulating a questionnaire among patients. Methods and Material: A questionnaire was prepared in local language, and circulated among patients scheduled for various elective surgeries in pre anaesthetic clinic. The questions were designed in such a way that each question is a leading question and they can answer either with yes or no form. Statistical Analysis Used: The answers marked by the patients were entered in to Microsoft excel sheet and percentages were taken. Results: Majority of the patients didn’t have the knowledge about the anaesthesia branch, and also pre anaesthetic checkup. Conclusions: We strongly feel that anaesthesiologist has a new task, to market himself, which would not only gain confidence but also help him to avoid legal issues.

Objectives: To compare the intubating conditions, clinical duration of action, cardiovascular responses, side effects associated with administration of rocuronium bromide 0.9mg/kg and succinylcholine chloride 1mg/kg for rapid sequence intubation. Study Design: Randomized controlled clinical trial. Place and Duration of the study: Rajah Muthiah Medical College, Chidambaram 201617. Methodology: After obtaining approval from institutional ethics committee and written informed consent from all patients, a randomized controlled double blinded clinical trial was conducted on 60 ASA I and II adult patients undergoing elective surgeries. Patients were randomly allocated into two groups group S and group R of 30 each. Patients in group S were to receive succinylcholine chloride 1 mg/kg and group R rocuronium bromide 0.9 mg/kg and intubation attempted at 60 seconds. Haemodynamic variables (heart rate, systolic, diastolic and mean arterial pressures) were recorded. Intubating conditions were graded using the score adopted by Toni Magorian et al [1]., and compared using Pearson’s Chisquare test. Conclusion: Rocuronium bromide 0.9mg/kg is a safe alternative to succinylcholine chloride 1mg/kg for rapid sequence intubation in adult patients in situations where succinylcholine chloride is contraindicated and where there is no anticipated difficult airway.

Aims and Objectives: To compare the combination new drug dexmedetomidine and bupivacaine with bupivacaine alone in terms of Onset and duration of sensory, and motor blocks, Duration of analgesia, Hemodynamic parameters and adverse effects. A prospective randomised double blind study done on 60 patients posted for various upper limb surgeries. They divided in two groups each including 30 patients, in which Group B received Bupivacaine 0.25% (30 cc) + 1ml normal saline. Group D received Bupivacaine 0.25% (30 cc)+ Dexmedetomidine 1 mg/kg + normal saline to make a total 31 ml. supraclavicular block given using peripheral nerve stimulator. We observed that, Demographic data and surgical characteristics were comparable in both the groups. The onset times for sensory and motor blocks were significantly shorter in B than A group (P < 0.001). Duration of blocks was significantly longer (P < 0.001) in B group. The duration of analgesia was significantly longer in B group than a group (P < 0.001). Hemodynamic parameters like HR, SBP, and DBP were lower in group B. We conclude that, Dexmedetomidine at the dose of 1 ug/kg body weight added as an adjuvant to 0.25% bupivacaine in supraclavicular brachial plexus block in upper limb surgeries is highly effective in prolongation of sensory analgesia and provides better post operative analgesia. So, the patients remain comfortable in the post operative period with considerable therapeutic benefit & without any potential side effects.

Context: Elderly patients exhibit the alterations in their physiological system. This affects the action of anesthetic agent in terms of spread, onset of action on motor block. Aims: Evaluating the efficacy of intrathecal Fentanyl as an adjuvant to intrathecal Bupivacaine (Hyperbaric) in patients undergoing transurethral resection of prostate. Settings and Design: Hospital based cross sectional study was conducted at SVS Hospital and Medical College, Mahabubnagar. Methods and Material: This study was conducted from November 2014 to November 2015. Informed consent was taken. 100 eligible patients as per inclusion and exclusion criteria were randomly grouped into 2 groups with 50 patients each. Group I received 1.5 ml of 0.5% hyperbaric Bupivacaine (7.5 mg). Group II received 1 ml of 0.5% hyperbaric Bupivacaine + 25 g Fentanyl. Parameters like Onset of motor block, Onset of sensory block, Time for two segment regressions, and Total duration of analgesia were studied. Statistical Analysis: The data was analyzed using statistical methods like Chi square Test, Repeated measure ANOVA, Independent samples T test. Results: Addition of Fentanyl 25 ìg to Bupivacaine resulted in significant faster onset of sensory block and motor block. The time taken to reach T10 dermatome level was also faster in group II. Time for two segment regression was faster in group II and was significant. Duration of analgesia was significantly prolonged in group II. Patients were aerodynamically more stable in group II. Conclusion: Intrathecal Fentanyl 25 g with 5 mg of hyperbaric Bupivacaine provides adequate and satisfactory anesthesia for TURP.

Introduction: Spinal anesthesia is characteristically associated with slowing of the rate. The degree of bradycardia as well as the frequency with which it can he roughly correlated with the extent of sympathetic denervation. Pronounced bradycardia is observed most frequently when cardiac output and arterial blood pressures have decreased significantly during anesthesia. Methodology: 60 patients selected for this study were randomly divided into two groups; each group comprised of 30 patients each. Written informed consent was taken from all patients who participated in the study. Preoperative assessment with complete history, general physical examination and systemic examination was done for each patient along with airway assessment and spinal column examination. Results: The changes in heart rate at different intervals of time was not found to be statisticallysignificant between two groups. In group DB, the mean difference of heart rate from basal to 90 minutes, was 10.47 minutes and whereas among PB group, it was 3.83 minutes. This implies that heart rate reduction is more in case of DB group compared to PB group but it was not statistically significant Conclusion: There was a difference in basal MAP between two groups which was not statically significant.

Introduction: Platelet dysfunction is consideredto be a major cause of bleeding after cardiac surgery following tranexamic Cardiopulmonary Bypass (CPB), resulting in an increased need for transfusions. Lysine analogues such as  acid, inhibit fibrinolysis by attachment to the lysine binding sites on plasminogen and plasmin and prevent fibrinolysis by blocking engagement of these fibrinolytic proteins with fibrinogen and fibrin. Aim: In this study, we sought to determine whether Regimen 1 (continuous infusion of tranexamic acid) preserves platelet function when compared to Regimen2 (bolus dose of tranexamic acid). Material and Methods: Regimen1 Tranexamic acid 10mg/kg IV after induction before skin incision followed by 1mg/kg/hr infusion. Regimen2 Tranexamic acid 10mg/kg IV after induction before skin incision followed by 5mg/kg bolus in pump prime and 5mg/kg IV after protamine administration. Results: There was no statistically significant difference between the two groups or within the same group at different time periods with regard to platelet aggregation. Conclusion: Either continuous or intermittent methods of tranexamic acid in patients undergoing open heart surgery may be used for pharmacological prophylaxis for bleeding.

Background: Airway management is of one of most important task during delivery of general anaesthesia. It was then established that laryngotracheal stimulation can lead to sympatho adrenal stimulation. This can cause a sudden rise in blood pressure leading to left ventricular failure, cerebral haemorrhage and myocardial ischemia. In normotensive patients laryngoscopy and insertion of an endotracheal tube is immediately followed by an average increase of mean arterial pressure of 25 mm Hg. There is no evidence that this effect causes lasting damage in normotensive patients. It was concluded that the use of the laryngeal mask airway (LMA) may therefore offer few advantages than tracheal intubation in the anaesthetic management of patients where the avoidance of pressor response is of particular concern. Objective: 1. To determine the pressor response elicited by laryngoscopy and endotracheal intubation in ASA I and ASA II patients, undergoing elective surgeries. 2. To determine the pressor response elicited by laryngeal mask insertion in ASA I and ASA II patients, undergoing elective surgeries. 3. To study the difference between the pressor response seen with ETT and that seen with LMA in patients undergoing elective surgeries. Methods: A hospital based prospective randomized study was conducted to determine the haemodynamic response elicited by laryngoscopy and endotracheal intubation and we compared the response with that elicited by laryngeal mask insertion in ASA I and ASA II patients, listed for elective surgeries. Either an ETT or LMA was inserted after induction of anaesthesia. Evaluations included measurement of heart rate and blood pressure before insertion, after insertion of device, 1 minute, 3 minutes and 5 minutes after insertion.Results: In a prospective randomized trial, 60 ASA I and II children weighing between 8 to 45 kg in the range of 2 to 14 years of age, planned for elective surgery were randomly allocated to one of the two groups of 30 patients each. The change in pressor response was significantly higher in endotracheal intubation children as compared to LMA placement. Furthermore these changes persisted for longer duration in children with endotracheal intubation in comparison to LMA insertion (5 min vs 3 min). Conclusion: LMA can be routinely used as a safe and effective alternative airway device to endotracheal intubation for positive pressure ventilation in pediatric patients’ listed for elective surgical procedure.

Context: Several adjuncts are added to local anaesthetic agents to prolong the duration of regional blockade. In this study, we added dexmedetomidine to levobupivacaine for supraclavicular brachial plexus blocks. Aim: To compare the effectiveness of 50 mcg dexmedetomidine added to 0.5% levobupivacaine in supraclavicular brachial plexus block for upper limb surgeries with respect to onset and duration of motor and sensory blockade. Settings and Design: We conducted a randomized double blinded controlled trial on 40 patients, undergoing supraclavicular block. Methods and Material: Group A (n=20) received 30 ml of 0.5% levobupivacaine with 0.5 ml of normal saline and Group B (n=20) received 30 ml of 0.5% levobupivacaine with 0.5 ml of dexmedetomidine (50mcgs/0.5ml). Time of onset, completion and duration were noted for both sensory and motor blockade. Statistical Analysis Used: Chisquare test and student ttest and p value <0.05 was considered as significant. Results: Onset of motor and sensory blockade was significantly shorter with Group B (0.5% levobupivacaine with dexmedetomidine). The mean duration of sensory and motor blockade was significantly prolonged with 591± 30min. and 543±32min respectively. The mean sedation score was 2.60±0.503 (patients were sedated and arousable to verbal or mild physical stimulus) in Group B whereas the score was 1 (fully awake) in Group A. All patients were hemodynamically stable. Conclusion: We conclude that addition of dexmedetomidine 50mcgs to 0.5% levobupivacaine fastens the onset and prolongs the duration of motor and sensory blockade and provides good intraoperative sedation

Background: Intrathecal dexmeditomedine is being used as an adjuvant to the local anesthetic agents. Dexmeditomedine has sedative and analgesic action. This study was carried out with the aim to observe and compare the onset and duration of sensory and motor block, duration of analgesia, hemodynamic changes, level of sedation and side effects between the two groups, i.e. Intrathecal hyperbaric bupivacaine v/s low dose dexmeditomedine and bupivacaine combination in patients posted for routine gynaecological surgeries. Methods: This was a prospective randomized controlled double blind study. Sixty adult female patients were divided into two groups. Group (B+D) received intrathecal 0.5% hyperbaric bupivacaine 17.5 mg (3.5 ml) with inj. Dexmeditomedine 10µg in 0.5 ml of normal saline and group (B+S) received Intrathecal 0.5% hyperbaric bupivacaine 17.5mg (3.5 ml) with 0.5 ml of normal saline. The assessment of the parameters like the onset time for sensory and motor block, regression time of the block to two dermatomes, T10 dermatome, S1dermatome, Bromage 0 motor block and the time for request of first rescue analgesic dose was done in both groups. Also, the incidence of untowards side effects like bradycardia, hypotension, shievering and the sedation score in each patient was noted. Statistical analysis was carried out. Results: There was no statistical difference in the time of onset of sensory and motor block in both the groups. However, the time for regression of sensory block in the dexmeditomedine group to two dermatomes (188.87±81.79 min), T10 dermatome (225.67± 32.51 min ), S1 dermatome (261.80± 79.50 min ) and motor block to Bromage scale 0(326.33±76.80 min ) was significantly prolonged than in group (B+S)(109.67± 25.31,147.67± 32.12, 180.33± 30.73 &203.67± 28.69 min). The time for first request of rescue analgesic dose was significantly longer in dexmeditomedine group (360.67±80.19 min )than in normal saline group(203.66± 48.75 min). Differential Analgesia (DA) was evaluated as the difference between the time for rescue analgesic dose request and recovery of muscle power to Bromage 0 scale. It was significantly longer in (B+D) group (34.33± 30.11 min), whereas its presence was inconsistent (sometimes absent) in (B+S) group (mean value 10.33±18.94 min). Conclusion: Intrathecal dexmeditomedine 10 µg, added to hyperbaric bupivacaine is useful for gynecological surgeries, with minimal and easily treatable side effects and prolonged postoperative analgesia, even after cessation of block (Differential Analgesia). Also, it is helpful to avoid general anesthesia, even if the surgical procedure gets prolonged.

Background: Postoperative pain control is generally best managed by anaesthesiologists since they offer regional anaesthetic techniques as well as pharmacological expertise in analgesics.Various postoperative analgesic modalities are offered in day to day practise such as oral or parenteral analgesics, peripheral nerve blocks, neuraxial blocks with local anaesthetics, intraspinalopioids TENS and others. Use of traditional NSAIDs have many side effects like gastritis, pepticulceration, bleeding from upper G I tract, delayed platelet inhibition, headache, vertigo, insomnia, bronchospasm, allergic reaction, anaemia, nephrotoxicity, salt and water retention.In contrast to NSAIDs, cox2 inhibitors like Parecoxib are free from adverse effects and drug dependence.Hence we thought it is appropriate to study the haemodynamic and adverse effects of intramuscular Parecoxib for post operative pain relief. Materials and Methods: This study comprised of 100 postoperative patients of both sexes betweenage group of 1870 years who were scheduled for various elective surgical proceduresand all thosewho satisfied inclusion and exclusion criteria. All patients are visited preoperatively; written consent was taken and premedicated with diazepam 0.2 mg/kg body weight at night. Parecoxib sodium 40 mg given in the recovery room, when patient complained of pain. Heart rate and blood pressure were recorded at intervals.  Adverse effects were noted. The observation were recorded, tabulated and subjected to statistical analysis. Results: In the study group, 45 were males and 55 were females. There was no significant change in blood pressure or heart rate for 28 hours after intramuscular administration. There were 9% of patients with nausea and vomiting, 4% with headache and 3% with pruritus. Conclusion: Intramuscular Parecoxib provides good postoperative analgesia with no haemodynamic variations and minimal adverse effects.

Background: Electrolyte values are measured both by arterial blood gas (ABG) analyzers and central laboratory autoanalyzers (AA), but a significant time gap exists between the availability of both these results, with the ABG giving faster results than the AA. The authors hypothesized that there is no difference between the results obtained after measurement of electrolytes by the ABG analyzers and AA. Methods: We retrospectively analyzed the 122 sets of arterial blood samples from critically ill patients. Whole blood electrolytes were analyzed using a pointofcare blood gas (ABG) analyzer and serum electrolytes were analyzed in the central laboratory autoanalyzers. Results: There was a significant difference in the mean (± standard deviation) sodium value between whole blood and serum samples (134.59±13.11 Vs 144. 20±14.11). There was a significant difference in the potassium values measured by ABG analyzers and AA (3.37±0.68 Vs 3.52 ±0.70). The correlation coefficient obtained for sodium was 0.931 and correlation coefficient obtained for potassium was 0.894. Conclusion: Results with two different measurement technologies differed significantly for plasma sodium and potassium concentrations.Therefore, clinicians should be careful when diagnosing sodium and potassium ion imbalance in critically ill patients and providing treatment.

Airway management is most important job of anaesthesiologists. Difficult airway is assessed mainly comparing different parameters of airway assessment. In this study we mainly compare Upper Lip Bite test (ULBT) and Modified Mallampati Test (MMT) for prediction of difficult intubation. We have taken 100 patients’ database from RIMS Ranchi hospital, study have been done in all patients undergoing general anaesthesia. After database is designed, data are processed through SPSS and Excel software analysis. In this case we have gone through 100 patients and subsequently after grading ULBT and MMT, taking Cormack Lehane Grading as standard one. Comparison done on the basis of sensitivity, specificity, positive predictive value, negative predictive value, accuracy. It was observed from the study that MMT is better predictor of difficult intubation than ULBT. Both are predictors of good predictors of easy intubation rather than difficult intubation.

Context: Availability of large number of agents which prevent emesis and continued research for newer drugs to treat emesis indicated the magnitude of the problem and lack of satisfactory regimes. Aims: To study the effectiveness of granisetron in reducing the incidence of post operative nausea and vomiting in patients undergoing lower segment cesarean section. Settings and Design: Hospital based cross sectional study was conducted at SVS Hospital and Medical College, Mahabubnagar. Methods and Material: 75 women of ASA gradel and 2 aged between 2035 years weighing between 4565 kg at term posted for elective cesarean section under spinal anesthesia were enrolled for the study. Patients were randomly allotted into three groups of 25 each. Patients belonging to group A received injection Ondansetron 4 mg, group B received injection Granisetron 2 mg and group C received injections normal saline 2 ml IV. Statistical Analysis: Patient data were analyzed by ChiSquare test and p value less than or equal to 0.05 was taken as statistically significant. Results: Incidence of post operative nausea and vomiting (PONV) was more in control group i.e. 44% and it was only 16% in the granisetron group. Among the patients with ondansetron group it was 20%. Granisetron was found to be effective in controlling the vomiting compared to placebo and ondansetron. In group A, 4 patients, in group B, 3 patients and 1 patient in group C had headache. Conclusion: Granisetron 2 mg was slightly more effective than IV Ondansetron 4 mg in preveting PONV following cesarean delivery under spinal anesthesia.

Introduction: For lower abdominal and lower limb surgeries the neuraxial blockade is the preferred mode of anesthesia. In recent years, use of intrathecal adjuvants like dexmedetomidine has gained popularity with the aim of prolonging the duration of the block, better success rate, and patient satisfaction, decreased resource utilization compared with general anesthesia and faster recovery and adequate postoperative pain management. The present study was aimed to evaluate the role of dexmedetomidine when added to heavy bupivacaine 0.5% intrathecally. Material and Methods: A doubleblinded randomized controlled trial conducted on 76 patients undergoing infraumbilical surgery, during the period from 1st of January 2016 till December 2016. Patients were randomly divided into one of two groups. The first group (A) received the drug (Dexmedetomidine) with Bupivacaine while the second group (B) received Bupivacaine plus saline. Results: The mean SBP was lower among group (A) 132.9 ± 11.0 mmHg compared to group (B) 143.0 ± 10.3 mmHg and mean DBP was significantly lower among group (A) 78.7 ± 11.1mmHg compared to group (B) 82.3 ± 12.1mmHg at all recorded timing intraoperatively. The mean time to reach T8 sensory level was 3.8±1.0 min and mean time to Bromage 3, was 11.9±1.8 min that is less than group B, 4.2±1.2 min and 13.1±2.2 min respectively. Analgesia requirements were significantly lowered among group (A) as compared to group (B).The most frequent complications observed among the group (A) were sedation 15(39.47%), bradycardia 12 (31.57%) and hypotension 18 (47.36%). Conclusion: It was concluded that adding Dexmedetomidine along with local anesthetic provides adequate sensory and motor block, reduces intraoperative and postoperative analgesic requirements, and reduces postop complications with no sedation or neurologic complications.

Context: As the Frequency of cesarean section birth continuous to steadily rises worldwide the type of anaesthesia provided has gained importance. Though the anaesthesia has become very safe over the years some studies showed adverse Neonatal outcome in the babies delivered by cesarean section under general anaesthesia however this outlook needs to be further studied hence we aimed to compare the effect of general anaesthesia and spinal anaesthesia on foetal outcome delivered by cesarean section by monitoring APGAR & NACS scores. Aims: Settings and Design: Prospective Randomized Controlled clinical trail in tertiary level institute. Methods and Material: Our study was conducted in 100 patients with elective indications patients was randomly divided into general anaesthesia (in 50 patients) and spinal anaesthesia (50 patients). The APGAR score and neonatal neurological adaptive capacity score (NACS) were noted and the results were compared with the groups. The maternal age, height, weight, time taken for delivery of baby after induction & NICU admission were also noted and compared with groups. Statistical Analysis Used: Mean and standard deviation, unpaired t test. Results: There was no significant difference in spinal versus general anaesthesia group regarding age (26.34±3.61 vs 26.26±3.43), weight (75.36±6.33 vs 71.03±8.20) and height (5.21±0.16 vs 5.18±0.14) time taken for delivery of baby was statistically insignificant in both the groups percentage of NICU admission in the babies delivered under general anaesthesia group was high (28%) as compare to babies delivered under spinal anaesthesia group (10%) babies born to mothers underwent spinal anaesthesia had significantly better APGAR score after delivery (7.18±1.00 vs 6.1±0.70 P<0.001, 1 minute (8.30±1.00 vs6.82±0.89 P<0.001) and 5 minute (8.56±1.07 vs 7.54±0.76 P< 0.001) APGAR score. Neonate Neurological adaptive capacity score (NACS) at 15 minutes and 2 hours were better in spinal anaesthesia group compare to general anaesthesia group. Conclusions: NACS score and APGAR score were better preserved in neonates born to mother under spinal anaesthesia for elective cesarean section so this could be a base to recommend the spinal anaesthesia as a standard anaesthesia technique for cesarean section, though should be further evaluated.

Aim: The aim of the study is to compare the following factors in two groups i.e., Hyperbaric bupivacaine 0.5% and Buprenorphine 60mcg (GROUP B) and Hyperbaric bupivacaine 0.5% and Tramadol 25mg (GROUP T). Patients and Methods: Inpatients, posted for major surgeries, below umbilical level, in Osmania general hospital and Govt. maternity Hospital, Hyderabad were choosen for the study. Inclusion Criteria: ASA physical status, class I and II, Age between 1860 years of either sex. Exclusion Criteria: Emergency surgery, deformities of spine, hypersensitivity to any of drugs, contraindications to spinal anaesthesia, patient refusal, bleeding diathesis. Results: A total of 100 patients of ASA Grade 1 and 2, between the age group of 1865 years who were undergoing lower limb and lower abdominal (Below umbilical) surgeries included in the study. They were randomized into two groups group B and group T which were given 3ml of 0.5% hyperbaric bupivacaine + 60 mcg of buprenorphine and 3ml of 0.5% hyperbaric bupivacaine + 25 mg of tramadol respectively. Preanesthetic checkup was done one day prior to the surgery. Patients were evaluated for any systemic diseases and laboratory investigations recorded. The procedure of SAB was explained to the patients and written consent was obtained. The patients were educated about the use of visual analogue scale. Preparation of patients included period of overnight fasting. Patients were premedicated with Tab.Rantac 150mg and Tab.Alprazolam0.5mgH/S. Time of onset of sensory block was tested with pin prick which was not significantly differed in both the groups but duration of sensory blockade (225.68±41.88 min), motor block (204.58±34.45 min) and duration of analgesia (291±33.7 min) were more with buprenorphine than tramadol which were 187.32±8.31, 153.32±7.93, 169.34±10.51 respectively. Heart rate, blood pressure, respiratory rate, saturation all were comparable in both the groups throughout the intraoperative period. Intraoperatively sedation score was assessed using Modified Ramsay Sedation Scale and there was higher incidence of sedation with Buprenorphine group. Nausea and vomiting were significantly higher in group T, with p value <0.001. Hypotension and bradycardia were more in group B which is statistically insignificant. Sedation scores were higher at 30 min in group B which was statistically insignificant with p=0.04, and higher again at 60 min and 90 min which is statistically significant with p value <0.01. At 120 min sedation scores were slightly higher in group T, but statistically insignificant with p value 0.67. sedation scores at 150 min and 180 min in two groups were comparable and statistically insignificant with p value 1. In our study postoperative analgesia was assessed by VAS at 6hr, 12hr, 18hr, and 24hr. The scores were lower in buprenorphine group than tramadol group which was statistically highly significant with p values < 0.001.Conclusion: To conclude, Buprenorphine (60 mcg) seems to be an attractive alternative to tramadol (25 mg) as an adjuvant to spinal bupivacaine in surgical procedures. It provides good quality of intraoperative analgesia, haemodynamically stable conditions, and excellent quality of postoperative analgesia. Hence, Buprenorphine seems to be a better choice as Intrathecal adjuvant with Bupivacaine when compared with Tramadol. 

Background and Aims: Shoulder surgery is associated with significant postoperative pain. A continuous interscalene brachial plexus block provides an excellent postoperative analgesic modality for early rehabilitation and recovery. The aim of this study was to compare the efficacy between Ropivacaine 0.2% and Bupivacaine 0.125% with respect to Quality of analgesia, Motor block, Patient satisfaction, Hemodynamic effects and Complications. Methods: Hundred patients scheduled for shoulder and upper arm surgeries between 1875yrs of ASA 1, 2, 3 were prospectively randomized by sealed envelope technique into 2 groups of 50 each. GroupA: 0.125%Bupivacaine, GroupB: 0.2% Ropivacaine. Patients with COPD, localized infection and Catheter dislodgement were excluded. Ethics committee approval was granted and patients consent was taken. Data was analyzed with the help of MannWhitney test, Chisquare test and SPSS software version 21.0. Interscalene catheter was placed using ultrasound following which all patients received general anaesthesia. At the end of the surgery, 10 ml of either bupivacaine or ropivacaine was given followed by continuous infusion at 5ml/ hour post extubation that continued upto 48 hours. A 5ml bolus of same drug was given as rescue analgesia. Quality of analgesia was assessed by VAS score, motor block was assessed by hand strength scoring them on a scale of 1 to 3. Results: VAS score remained less than 2 in both groups(p >0.05). Motor blockade was 19% in Bupivacaine, compared to 2% in Ropivacaine (p <0.05). Catheter dislodgement was found to be 16%. Conclusion: Ropivacaine 0.2% and Bupivacaine 0.125% provide good and comparable postoperative analgesia with bupivacaine causing statistically significant motor blockade.

Background: Regional block has evolved with passage of time from being a blind process to the use of ultrasound giving an “eye” to the process. Evolution of technology and pharmacology has helped anesthesiologist in many ways. 2 receptor agonist has been used since long for precisely controlling characterstics of peripheral nerve blocks. This study was aimed to compare the efficacy of dexmedetomidineand clonidineas an adjuvant to local anesthethic in USG guided supraclavicular brachial plexus block. Methods: Our study included 80 ASA Grade I & II patients, scheduled for various upper limb orthopaedic surgeries and were randomly allocated into Groups RC & Group RD. Group RC received Ropivicaine 0.5% (30 cc) + Clonidine 1µg/kg and group RD received Ropivicaine 0.5% (30 cc) + Dexmedetomidine 1µg/ kg. Blockcharacterstics, duration of analgesia and any complications encountered were compared. Results: Mean onset of sensory block in group RD and group RC was 7.525 ± 0.640 and 8.03± 0.77 minutes respectively. The mean onset of motor block in group RD was 13.97± 1.0 minutes as compared to group RC 14.5± 1.04 minutes. Mean duration of analgesia in group RD was 444.5± 50.12 minutes compared to 303.5± 36.07minutes in Group RC. Conclusion: Dexmedetomidineis more efficacious than clonidine as an adjunct to ropivacaine in supraclavicular brachial plexus block due to its more precise control of block characterstics with prolonged duration of analgesia postoperatively.

Background: Low Back Pain (LBP) is the leading cause of disability in adults. Aetiology of low back pain is usually multifactorial [1]. The aim of this study is to assess the effectiveness of epidural steroid injection in lower back pain. Materials and Method: This is a prospective study of 64 patients conducted at Basaveshwara Medical College and Hospital over a period of 2 years from January 2014 to December 2015. Injection methylprednisolone 80 mg with 2ml of 0.5% bupivacaine was diluted in 6ml of normal saline and injected into the lumbar epidural space in a selected group of patients. Revised Oswestry Disability Index (ODI) and Visual Analogue Score (VAS) were used for evaluation during follow-up. Results: In our study, 64 patients received epidural steroid injections. Among 64 patients 4 patients did not come for follow up and 8 patients required surgery after the first injection. The remaining 52 patients were analyzed. The mean age of patients was 40.5 years. Disc prolapse was involved at L4L5 in 20 patients (38.46%). Single-level disc prolapse was seen in 34 patients (65.38%). Degeneration of the spine was associated in 8 patients. During follow up functional status and pain response of patients was improved significantly. Conclusion: Epidural steroid injection is an effective and safe method of treatment for chronic low backache patients.

Central neuraxial blockade in the form of epidural is very popular for lower abdominal and lower limb surgeries as these techniques avoids the disadvantages associated with general anaesthesia like airway manipulation, poly pharmacy and other untoward effects like postoperative nausea,vomiting, need for supplemental intravenous analgesic. Despite of many different local anaesthetics we are still looking for the ideal one. Levobupivacaine and ropivacaineare getting more popularity due to their prolonged duration of action and less cardio/neurotoxicity. This randomized prospective studyon sixty patients aged between 2060 years of either sex belonging to ASA class I and class II posted for elective lower limb orthopaedic surgeriescomparedsingle dose epidural 0.125% levobupivacaine and single dose epidural 0.2% ropivacaine for postoperative analgesia and showed that levobupivacaine produces higher postoperative analgesia as compared to ropivacaine.