Indian Journal of Anesthesia and Analgesia

Introduction: Regional nerve block anaesthesia offers many clinical advantages that contribute to improved patient outcome and lower healthcare costs.In patients with End Stage Renal Disease, a permanent vascular access through surgical construction of an arteriovenous fistula (AVF) is essential. However, many of these patients have severe comorbidities, which can lead to serious complications during general anesthesia.  Brachial plexus block attenuates the side effects of general anesthesia in patients undergoing AVF construction. Our aim was to compare two methods of nerve localisation – elicitation of paresthesia versus nerve locator with regards to technical feasibility and ease of nerve localization, onset and the time to establish complete surgical anaesthesia and to determine the success rate,quality of block and failure rate between the two methods.

Materials and Methods: A randomized controlled trial was conducted in to a near 1200 bed tertiary care hospital. The study population included patients who underwent AV fistula creation between a specified six months period. After obtaining written informed consent, patients fulfilling the study criteria were allocated randomly into two groups. Group (1) P – where nerve localization will be carried out by paresthesia technique. Group (2) PNL – where nerve localization will be done by peripheral nerve locator. The patients in both groups were monitored for the onset, duration, success or failure of block, sequelae and such other variables as required for fulfilling the objectives.

Results: In paresthesia group the time to localise the nerve was observed to be significantly less (p<0.05) as compared to the nerve locator group.The time for onset of block, latency of block, complete surgical analgesia, duration of surgical analgesia and postoperative analgesia did not show any statistical significance (p>0.05) between the paresthesia and nerve locator groups. The paresthesia group had nine cases and nerve locator group had four cases who required supplementation to achieve complete surgical analgesia. The success rate of nerve block was 91.1% in nerve locator group compared to 80% in paresthesia group.

Conclusion: Peripheral nerve locator appears to be more useful particularly when the block of deep seated plexus or nerves is desired. Although nerve locator may not help in improving the onset of block, latency of block or time to achieve complete surgical anaesthesia, the success ofperipheral nerve locator can be attributed to a lesser risk of tissue injuries like vascular punctures and direct nerve trauma.

Coronary artery bypass grafting (CABG) surgery is still the predominant operative procedure for myocardial revascularization. The pressor response to intubation is a detrimental factor in these patients, where stable hemodynamics is desired. Use of various intubation aids, is one of the methods by which this could be minimised. Hence, we decided to compare the haemodynamic changes to endotracheal intubation after conventional laryngoscopy versus the use of intubating laryngeal mask airway. We also aimed at comparing the ease of intubation and the complications of the above two intubation methods.

Methods: Prospective, randomized, double blinded study in 60 patients between 30-75 yrs age group of either gender, scheduled for elective CABG surgery. patients were evaluated preoperatively and were randomly allocated into group I & group II consisting of 30 patients each using computer generated numbers. General anaesthesia administered and for patients in group I ILMA was used and in group II conventional laryngoscopy and endotracheal intubation was done. Haemodynamic parameters (blood pressure, heart rate, ST segment analysis)were recorded at different time intervals and the occurrence of adverse events such as oxygen desaturation and soft tissue trauma was also noted.

Results: The time taken for intubation (represented as Mean SD) was found to be 108.5 (± 36.8) seconds in group I, 22.5 (±11.7) seconds in group II with a p value of 0.0001. There was no statistically significant changes in the haemodynamic parameters (heart rate, blood pressure, ST segment changes) between both the groups. However, statistically significant intragroup comparisons were found. The incidence of intraoperative complications was found to be 6.6% in group I and 3.3% in group II. Thus we concluded that, intubation through intubating laryngeal mask airway takes more time than conventional laryngoscopy and endotracheal intubation but offers no advantage when stress response to intubation is concerned in patients undergoing CABG.

Background: Fentanyl, an opioid and dexmedetomidine, an alpha 2 agonist added to local anaesthetics in spinal anaesthesia potentiates local anaesthetics action, have analgesic properties and reduces the requirement of local anaesthetics.

Aim: To evaluate the effect of adding fentanyl and dexmedetomidine to intrathecal isobaric levobupivacaine.

Materials and Methods: 60 patients scheduled for lower abdominal surgeries at our institute belonging to ASAgrade I-II satisfying inclusion criteria were recruited for the study and randomised to receive levobupivacaine 15mg with dexmedetomidine 5µg in group LD or levobupivacaine 15mg with fentanyl 25 µg in group LF. Sensory and motor block characteristics, haemodynamic changes and side effects were recorded.

Results: Onset of sensory block was shorter, time taken to attain maximum sensory block was shorter in group LD as compared to group LF with no stastistical significance. Maximum sensory block achieved was T4 in both the groups. Onset of motor blockade was faster and time taken to attain maximum bromage score 3 was faster in group LD as compared to group LF. Two segment regression duration, duration of analgesia, duration of sensory blockade and motor blockade were stastistically significantly prolonged in group LD as compared to groupLF. Patients maintained haemodynamic stability. Sedation scoring and side effects were insignificant. Data was analysed using Chi-square test and Independent t test.

Conclusion: Dexmedetomidine as an adjuvant to isobaric levobupivacaine for spinal anaesthesia fastens sensory, motor onset and enhances the block duration without any significant side effects as compared to fentanyl.

Background: Paediatric patients undergoing lower abdominal surgeries require adequate pain relief peri operatively, which is often neglected. Various methods of pain relief in paediatric patients are systemic opioids, NSAIDS and regional anaesthesia techniques like caudal block. Recently a newer technique i.e. ultrasound guided transversus abdominis plane (TAP) block is being taken into consideration. Therefore, we aimed to compare efficacy of USG guided TAP block Vs. Caudal block in paediatric patients undergoing lower abdominal surgeries for post-operative analgesia.

Methods: Fifty patients were randomly allocated in two equal groups- group A received TAP block and group B received caudal block. Our study included children of age group one to ten years posted for lower abdominal surgeries. Both the blocks were performed after same general anaesthesia technique. We compared requirement of intra-operative additional analgesia, vital parameters, post op pain score and time of rescue analgesia. The entire data was statistically analyzed using SPSS software. The inter-group comparison is done using Chi-square test/ Fisher’s exact probability test.

Result: Intra-operative pulse rate did not differ significantly between two groups. The average requirement of intra-operative analgesia did not differ significantly in both the groups. The average post-operative Pain Score was significantly higher in group B compared to group A after 180 min (p=0.001). Significantly higher proportion of children from Group B required rescue analgesia compared to Group A (p=0.001).

Conclusion: We conclude that USG guided TAP block is better alternative to caudal block for post operative analgesia in children undergoing lower abdominal surgeries.

Background: Cesarean section (CS) is one of the most common surgical procedures today. About 20-25% of all birth is by CS. Surgery and anesthetic technique employed has been shown to effect postoperative outcomes, specifically effecting the length of hospital stay. Hence; present study was planned to assess and compare the efficacy of spinal anaesthesia and general anaesthesia in patients undergoing CS.

Materials & Methods: The present study included evaluation and comparison of efficacy of spinal and general anaesthesia in patients undergoing caesarean section. A total of 30 subjects were included in the present study and were broadly divided into two study groups; group 1 and group 2 with 15 patients in each group. Group 1 included patients which underwent caesarean section under general anaesthesia and group 2 included patients which underwent caesarean section under spinal anaesthesia. All the patients underwent complete haematological and biochemical investigation before the starting of the surgical procedure. Complicate demographic details of all the patients were recorded. Presence of any postoperative complication were also evaluated and recorded. All the results were analyzed by SPSS software.

Results: A total of 30 pregnant females were included in the present study and were broadly divided into two study groups with 15 females in each group. Mean age of the patients of group 1 and group 2 was 33.5 years and 34.1 years respectively. Mean gestation weeks of patients of group 1 and group 2 were 38.5 weeks and 38.4 weeks respectively.Number of hypotensive patients observed in group 1 and group 2 after procedure were found to be 2 and 8 respectively. Significant results were obtained while comparing the total intraoperative fluid requirement and number of ephedrine requiring patients in between both the study groups.

Conclusion: In comparison to spinal anaesthesia, general anaesthesia is comparatively better for patients undergoing elective caesarean section.

Objective: The aim of this study is to evaluate and compare the clinical effects of added dexmedetomidine to epidural ropivacaine 0.75% for lower limb orthopedic procedures.

Methods: 40 patients undergoing elective lower limb orthopedic procedures under epidural anesthesia were selected and divided into two groups of 20 each and assigned into Control Group (N=20): Epidural ropivacaine 0.75% 20ml (150mg)+1ml NS, Dexmedetomidine Group (N=20): Epidural ropivacaine 0.75% 20ml (150mg)+ Dexmedetomidine 1g/kg+NS to complete 1ml. Variables studied include: Block onset time, maximum dermatomal level of anesthesia, duration of sensory and motor blockade, motor block intensityassessed by bromage motor scale, sensory block assessed by sensory scale, level of sedation assessed by ramsay sedation scale, hemodynamics, duration post operative analgesiavas score

Results: Duration of analgesia was prolonged in Dex group, level of significance (p<0.05), Motor block duration was prolonged in Dex group, level of significance (p<0.05), Intensity of motor block slightly increased in dex group, but without significance (p<0.37), need for Supplemental sedation was reduced need in Dex group, level of significance (p<0.05), Duration of post-op analgesia was significantly prolonged in Dex group when compared to control group, level of significance (p<0.001).

Conclusion: There was a clear synergism between epidural dexmedetomidine and ropivacaine. Dexmedetomidine increases sensory and motor block duration during epidural anesthesia with ropivacaine, prolongs postoperative analgesia and does not cause hemodynamic instability.

Background and Aims: Pain is the most common symptom seen postoperatively and multiple approaches are used to overcome it. In this study, we compared bupivacaine and bupivacaine – clonidine combination in transversus abdominis plane (TAP) block for postoperative analgesia in patients undergoing inguinal hernioplasty under spinal anaesthesia.

Methods: Sixty ASA I and II male patients in the age group of 18 to 60 years posted for inguinal hernioplasty were randomly divided into two groups (Group B and Group C). The procedure was done under spinal anaesthesia using 3 ml of 0.5% hyperbaric bupivacaine. After the surgery, ultrasound guided TAP block was given with 19.5 ml of 0.25% bupivacaine + 0.5 ml sterile water in Group B and 19.5 ml of 0.25% bupivacaine + 75 mcg of clonidine (0.5 ml) in Group C. Postoperatively, the patients’ haemodynamic status, visual analogue scale (VAS) scores, dose of rescue analgesic used, duration of analgesia were recorded. Inj. Tramadol 100 mg was given intravenously as rescue analgesic when the VAS score was more than four. Data were analyzed using unpaired t test and Mann- Whitney test wherever indicated.

Results: The heart rates recorded at 6, 8, 10, 12 and 14 hours after TAP block were significantly lower in Group C compared to Group B (p< 0.05). The heart rates recorded at 16 and18 hours after TAP block were significantly lower in Group B compared to Group C. The mean arterial pressures (MAP) and VAS scores recorded at 6 and 8 hours after TAP block were significantly lower in Group C compared to Group B. The mean dose of tramadol administered was significantly lower in Group 96.67±18.25 mg) compared to Group B (186.67±34.57 mg) (p value 0.0001). The mean duration of analgesia was significantly higher in Group C (943.46±70.751 minutes) compared to Group B (413.20±45.023 minutes, p value 0.001).

Conclusion: Addition of clonidine to 0.25% bupivacaine for TAP block significantly prolongs the duration of analgesia and reduces postoperative analgesic requirements compared to patients receiving 0.25% bupivacaine alone.

Background: Induction of anaesthesia, laryngoscopy and intubation are critical events and hemodynamic stability is an important factor during this period. This study aims to evaluate the effect of dexmedetomidine on induction with respect to hemodynamic response, induction time and smoothness of induction also to evaluate the combined effect of dexmedetomidine with propofol and sevoflurane on cardiovascular response to laryngoscopy and intubation.

Methods: A total of 120 American Society of Anaesthesiologists physical status I and II patients undergoing elective surgical procedures under general anaesthesia were randomized into two groups. Both the groups received dexmedetomidine 1.0µg/kg diluted to 10ml, infused over 10min, 10min before induction. Group DP (Dexmedetomidine Propofol) received Inj propofol 1.5-2mg/kg titrated till the loss of verbal response (n= 60) andGroup DS (Dexmedetomidine Sevoflurane) were induced with sevoflurane 8% till loss of verbal response (n =60). Heart rate (HR) Mean arterial pressure (MAP) and rate pressure product (RPP) were recorded at baseline (T0), 2 min after administration of drug (T1), 1min after induction (T2) and at 1, 3, 5 and 10 min after intubation (T3, T4, T5 and T6 respectively).

Results: There was a significant decrease in mean arterial pressure and heart rate from pre-induction values within both groups after induction. The reduction in MAP and RPP was significantly more in group DP at 1min to 5min after intubation than group DS (p < 0.05).

Conclusion: Induction of anesthesia with Propofol and dexmedetomidine demonstrated a shorter induction time and greater decrease in mean arterial pressure at laryngoscopy and intubation.

Background: It has been several controversies about technique of choice for cesarean section in severe preeclampsia and eclampsia patients for several years. Though earlier general anesthesia was routinely used for giving anesthesia in such patients, in last 10 years the picture has changed. Now, spinal anesthesia is an anesthetic choice for patient with preeclampsia unless it is contraindicated because of hypocoagulation. It was therefore decided to compare the hemodynamics of severely preeclamptic and eclamptic patients undergoing general or spinal of anesthesia.

Material: We have studied 60 patients with severe preeclampsia and Eclampsia posted for emergency and elective caesarean section. All patients were divided randomly into two groups equally. All patients under the study underwent thorough pre-anaesthetic assessment including detailed case history, clinical examination and necessary investigations. All intraoperative and postoperative untoward complications will be recorded and treated.

Result:There was statistically significant at all readings where group II were significantly more tachycardic compared to group I patients except preoperative readings for pulse rate, SBP, DBP, and MAP.

Conclusion: We conclude that, severe preeclampsia and eclampsia patients undergoing spinal anesthesia, experience more hemodynamic instability (in the face of hypotension) than general group, but these changes are not severe, are transient, in the acceptable range and not influence the neonatal outcome. So, spinal anesthesia may be an appropriate anesthetic choice for woman with severe preeclampsia and stable eclampsia patients having cesarean delivery.

Introduction: Propofol is widely used for induction of anesthesia, although the pain during its injection remains a concern for all anesthesiologists. A number of techniques have been adopted to minimize propofol-induced pain. Various 5-hydroxytryptamine- 3 antagonists have shown to reduce propofol-induced pain. Hence, this placebo-controlled study was conducted to compare the efficacy of ondansetron, ramosetron, and lignocaine in terms of attenuation of propofol-induced pain during induction of anesthesia.

Aim of the Study: To assess the effectiveness of ondansetron and tramadol as pre-treatment in alleviating propofol injection pain.

Materials and Methods: 36 patients were randomly allocated into two groups. Group 1 who received up to 2 mL pretreatment with 50 mg tramadol with 1 ml NS while group 2 cases who received 2 mL pretreatment 4 mg ondansetron. The drug is injected into the largest vein on the dorsum of the hand by means of a 20 gauge cannula and the tourniquet being closed to the arm above the cannula and inflated upto 70 mmHg. The tourniquet is deflated after 20 seconds and propofol 2mg/kg injected over 10 seconds and assessment for pain was made.

Results: Tramadol and ondansetron both reduced the incidence and severity of propofol injection pain but pain reduction with ondansetron was significant compared to tramadol (p=0.0402). Significantly 14 patients in the ondansetron group felt no pain when compared to only 8 patients in the tramadol group.

Conclusion: In addition,ondansetron had the additional benefit as it controlled postoperative nausea and vomiting.

Introduction: Laryngoscopy and intubation increases sympathetic activity resulting in tachycardia and hypertension which may cause myocardial ischemia, cardiac arrhythmias and cerebrovascular hemorrhage. We compared the efficacy of intravenous esmolol and dexmedetomidine to attenuate the pressor response to laryngoscopy and intubation.

Design: Randomised controlled trial.

Method: Seventy-five patients of ASA I and ASA II undergoing general anesthesia with oral intubation for elective surgery were allocated into three groups.Group C: Control group. Group E: intravenous esmolol 2mg/kg three minutes before laryngoscopy. Group D: Intravenous dexmedetomidine 1g/kg in 100ml infusion over ten minutes before laryngoscopy. Heart rate, systolic, diastolic and mean arterial pressures were recorded before drug administration, after drug administration, after induction of standard anesthesia, immediately after intubation, every 2 minutes till 10 minutes. Incidence of bradycardia and hypotension were noted.

Statistical Analysis used: IBM SPSS version.

Results: Mean HR immediately after intubation for group C was (104.57±8.2) whereas it was (83±4.53, 92.6±4.70) for group D and group E with p value of (0.003,0.002) when compared to control group. While comparing group D and E, p value was 0.0001. MAP immediately after intubation for group C was (109±5.9) whereas it was (98±3.4, 100.2±5.2) for group D and E with p value (0.0001, 0.002) when compared to control group. While comparing group D and E, p value was 0.006.

Conclusion: Dexmedetomidine and esmolol both attenuated the pressor response to laryngoscopy and intubation but it was better controlled with dexmedetomidine.

The advantages of ambulatory surgery is effective when patients get the benefits of day care anaesthesia.This is possible by using rapid acting intravenous anaesthetic agents.

Aim: Comparative the effects of combinations of fentanyl -propofol with ketamine propofol in short gynaecological procedures. The null hypothesis was that there is no difference between the two groups.

Objective: Primary outcome: To compare the induction dose and top up doses of propofol in the two groups, one pretreated with fentanyl and the other group pretreated with ketamine. Secondary outcome studied were the quality of immediate and intermediate recovery measured by time to eye opening, time to sit up and walk in the two groups.

Materials and Methods: A randomised double blind study was conducted with Institutional review board and ethics committee approval. Forty ASA I and II physical status females with written informed consent for dilatation and curettage underwent the study. They were allocated to two groups by odd/even numbers by randomisation and blinded by by sealed cover method. Group I (F) received fentanyl citrate 1.5 microgram/kg intravenously and Group II (K) received ketamine 0.5mg/kg intravenously. Both groups of patients were induced two minutes later with tirated dose of propofol. In both groups anaesthesia was maintained with incremental doses of 25 mg propofol. The data was anlysed using unpaired t test.

Results: The mean induction time and the total dose of propofol was more in the F group. The time taken for eye opening was shorter in group F.

Conclusion: Anaesthesia with propofol-fentanyl was comparable with propofol-Ketamine for out patient anaesthesia. Recovery is rapid with fentanyl, with out emergence delirium and total absence of emetic sequelae.

Epidural analgesia by administration of bupivacaine has been considered as the Gold Standard for management of postoperative pain. On the other hand there is a paucity of literature on the efficacy of bupivacaine administered by Transversus Abdominis Plane (TAP) for postoperative pain relief in patients undergoing infra umbilical abdominal surgeries. The present study was carried out in a tertiary care medical college hospital in a rural setting to compare the efficacy of 0.375% Bupivacaine in the control of postoperative pain in patients undergoing infra umbilical abdominal surgeries when used in epidural space versus in the TAP.

Material and Methods: Sixty patients between 20 to 60 years of age of either sex in ASA grade I or II undergoing infra umbilical abdominal surgeries were divided into two groups of 30 each depending upon the route of administration of 0.375% bupivacaine either though TAP (Group T) or through epidural space (Group E). The parameters studied were variations in haemo-dynamics, quality of analgesia by VAS score, duration of analgesia by request for rescue analgesics, adverse effects if any and finally patient satisfaction for the postoperative pain relief.

Results: The Heart Rate (HR), Mean Arterial Pressure (MAP), Respiratory Rate (RR) and Oxygen Saturation (SpO2) were comparable between both the groups throughout the postoperative period with no significant change in haemodynamics from the baseline. The quality of postop analgesia in Group T was significantly better than in Group E as observed by lower VAS Scores at rest at various time intervals in Group T as compared to Group E ( p<0.05). Considerably higher scores for patient satisfaction for postoperative pain relief were observed in Group T as compared to Group E after 48 hours of administration of the study drug. (p<0.05). Considerably longer duration of postop analgesia was observed in Group T (420.03±30.42) as compared to Group E (240.27±30.1) which was statistically significant (p<0.05).

Conclusion: 0.375% bupivacaine is effective for postoperative analgesia in both the groups however TAP block holds considerable promise for patients undergoing infra umbilical surgeries and is an efficient alternative to epidural analgesia on account of its efficacy, safety, affordability and simplicity.

 Introduction: Central neuraxial adjuvant drugs, alone or in combination, are used intrathecally or epidurally for the treatment of acute and chronic painful conditions.

Aims: To compare the efficacy and duration of analgesia as well as to compare the hemodynamic parameters and the adverse effects of study drugs.

Method: 100 adult patients of ASA grade I and II, of either sex, belonging to 18 -65 years of age, posted for elective abdominal surgeries were selected for the study. Patients were randomly divided into two groups of 50 each. Group RT received 13ml of Inj. Ropivacaine hydrochloride (0.2%) + 1ml of Inj. Tramadol hydrochloride (50mg) + 1ml of Normal Saline. Group RF received 13ml of Inj. Ropivacaine hydrochloride (0.2%) + 0.5ml of Inj. Fentanyl citrate (25µg) + 1.5ml of Normal Saline. Total volume = 15 ml, by epidural route at the time of skin closure. Postoperatively, VAS Score at rest and movement, Ramsay sedation score, hemodynamic changes and adverse effects were noted.

Result: VAS at rest and movement were higher in Group RF at 6 hrs whereas in Group RT at 10 hrs. Ramsay sedation score were also comparable at 6 hrs and 10 hrs. Duration of analgesia was around 8 to 10 hours in Group RT whereas it was around 6 to 8 hours in Group RF.

Conclusion: Epidural Tramadol hydrochloride along with Ropivacaine hydrochloride provides significant longer duration of analgesia, lower pain scores as compared to Epidural Fentanyl citrate with Ropivacaine hydrochloride.

Background: Subclavian vein is generally preferred in ICU for central venous access. Infraclavicular and supraclavicular approaches are the two techniques of subclavian venous catheterisation. Infraclavicular approach to subclavian vein has been widely used. The supraclavicular approach is less often used though this approach of subclavian vein catheterisation has some distinct advantages. So aim of our study was to compare the supraclavicular and infraclavicular approaches of subclavian vein cannulation in terms of success rate and safety profile.

Methods: A total of 60 critically ill patients aged between 20-60 years of either sex admitted in ICU, where central venous catheterisation was indicated were enrolled in the study. Group I included 30 patients where right Subclavian vein cannulation was performed using Supraclavicular approach. Group II included 30 patients where right Subclavian vein cannulation was performed using Infraclavicular approach. The parameters recorded in the study included success rate of cannulation, number of attempts to cannulate the vein, time required to obtain the access and the various complications.

Statistically Analysis: The results of the study were compiled, tabulated and compared statistically using unpaired ttest and Pearson’s Chi-square test.

Results: The first attempt success rate in Group I (supraclavicular group) is significantally higher than in Group II (Infraclavicular group). The time required to access is also less in Group I ( supraclavicular) as compared to Group 11 (infraclavicular) and is statistically significant.

Conclusion: We concluded that supraclavicular approach has high first attempt success rate and also the time required to access is less as compared to infraclavicular approach.

 Background: There are various risk factors associated with Post Operative Sore Throat (POST). The objective of the study was to study the incidence of post operative sore throat in patients undergoing surgeries under general anaesthesia requiring endotracheal intubation.

Materials and Methods: A total of 175 patients fulfilling the inclusion criteria were enrolled in the study. The incidence of post operative sore throat was observed at 1, 6 and 24 hours post extubation and its correlation with the mallampatti score, designation of the intubating anaesthesiologist and the duration of surgery.

Results: In males the incidence was 50% and in females it was 47% with an overall incidence of 48%. In patients with mallampatti class 1 the incidence of POST was 41% and in class 2 it was 57.9%. Among the anaesthesists, 1st, 2nd and 3rd year PGs were 45.7 %, 50.7%, 48.6% and 44.4% respectively. The incidence of POST in patients in whom duration of surgery was between 1 to 2 hours was 39.4 %, 2 to 3 hours was 49.4 % and 3 to 4 hours was 68 %.

Conclusion: The incidence of POST has no significant difference between female and male patients. Lower mallampatti score is associated with lower incidence. Designation of anesthesist has no impact on the incidence. Lower the duration of surgery, lower the incidence.

 Background and Aims: We compared analgesic effect of dexmedetomidine and clonidine as adjuvant to 30 ml solution of 0.25% bupivacaine in ultrasound guided supraclavicular brachial plexus block.

Materials and Methods: Ninety patients scheduled for upper limb orthopedic surgeries were allocated to one of the three groups; control group B (n=30), clonidine group C (n=30), and the dexmedetomidine group D (n=30) in a randomized double blind fashion.  In group B 1 ml Normal Saline; in group C 1 ml Clonidine (0.75g/kg); and in Group D 1 ml Dexmedetomidine (0.75g/kg); were added to 30 ml of 0.25% bupivacaine and administered during ultrasound guided supraclavicular brachial plexus block. Patients were evaluated for onset and duration of sensory and motor block along with duration of analgesia, sedation, side effects, if any. Hemodynamic parameters were also monitored.

Results: The groups were comparable with respect to demographic parameters. Patients in group D had earlier onset as well as prolonged duration of sensory and motor block compared to group B and group C, which was statistically significant (p <0.001). Mean Duration of analgesia was 301.5± 48.7 minutes in group B, 456.7±75.8 minutes in group C and 585.0±99.4 minutes in group D. On comparison duration of analgesia was significantly prolonged in group D (p < 0.001).

Conclusion: Dexmedetomidine as adjuvant to local anaesthetic results in increased duration of sensory and motor block along with prolonged duration of analgesia as compared to clonidine.

Introduction: During laryngoscopy and endotracheal intubation, one of the most dreaded complications is hemodynamic instability which is a well-archived certainty and this response in most susceptible patients induces myocardial ischemia or infarction, left ventricular failure and cerebral hemorrhage due to the strong sympathetic response during the procedure.

The aim of the study: This study was aimed to compare the effect of dexmedetomidine and lidocaine on hemodynamic response to laryngoscopy and endotracheal intubation in patients undergoing elective laparoscopic procedures under general anaesthesia.

Materials and Methods: A total of sixty patients were selected and randomized into two groups of thirty patients each: dexmedetomidine-intervention group and lidocaine-control group. Inj. Dexmedetomidine by means of infusion pump was given prior to anesthetic induction, at a rate of 1g/kg IV over a period of 10 min, to all intervention group patients. Three minutes after the completion of infusion, patients were induced with general anaesthesia. As a standard procedure, plain preservative-free 2% lidocaine was given at a rate of 1.5 mg/kg IV bolus to all patients in the control group 1.5 minutes prior to laryngoscopy. Baseline parameters such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP), were recorded before administration of the drugs under study, at intubation, and at 1 min & 3 min after intubation.

Results: The changes in mean heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure values were significantly lower in Dexmedetomidine group when compared to the lidocaine group.

Conclusions: Dexmedetomidine when used as a pre-anesthetic medication significantly suppresses the sympathoadrenal response to laryngoscopy and endotracheal intubation without influencing intraoperative cardiovascular stability.

Background: Spinal & combined spinal epidural anaesthesia are the preferred techniques for facilitation of surgical fixation of the fractures of the lower limb. Extreme pain does not allow ideal positioning for these procedures. Intravenous fentanyl and femoral nerve block are commonly used techniques to reduce the pain during positioning for central neuraxial blockade.

Aim: Tocompare the analgesic effect provided by femoral nerve block, IV fentanyl and low dose IV ketamine given prior to positioning for central neuraxial block in patients undergoing surgery for lower limb fractures.

Material and methods: This is a prospective, randomized, comparative study conducted at Nizam’s Institute of Medical Sciences from June 2017 to August 2017. 60 patients with lower limb fractures were divided into 3 groups of 20 each - Group A (Femoral Nerve Block with 1% Lignocaine), Group B (IV Fentanyl - 1µg/kg) and Group C (low dose IV Ketamine – 0.1mg/kg). Baseline/pre-intervention VAS score was noted. Pain assessment was done using visual analog scale (0 = no pain, 10 = maximal pain). Depending on the group to which they were included, a particular intervention amongst the three was done for evaluating the analgesic efficacy for positioning for central neuraxial blockade.VAS pain scores were noted again 10 mts after the intervention. The difference in VAS pain score 10 mts after the intervention and baseline was derived at. Significant pain control was identified as the difference of at least 2 points on the VAS score before and after the procedure in an alert and conscious patient. Percentage of patients in each VAS strata (0= no pain, 1-3= mild pain, 4-6= moderate pain, 7-9= severe pain & 10= very severe pain) in comparision to total number of patients in each group (FNB, IV Fent, Low dose IV Ketamine) at different time points (before and 10 minutes after the specified intervention in each group ) was also noted and the percentage change in the specific vas strata of a group at different points of time was also calculated. Total number of patients in each group with VAS ï‚£ 3, 10 minutes after the intervention was noted.

Results: Baseline VAS scores in the 3 groups – Group A (FNB group): 7.55±1.47 vs Group B (IV Fentanyl group): 7.25±1.29 vs Group C (Low dose IV Ketamine group): 7.55±1.43, p = 0.737, statistically not significant . The baseline VAS scores were comparable amongst the 3 groups. The VAS score after 10 min in the 3 groups - Femoral nerve block group: 2.5±1.43 vs IV fentanyl group: 3.45±2.06 vs Low dose IV Ketamine group: 2.70±1.98, p= 0.238, statistically not significant. The difference of VAS scores before and after 10 min after the specific intervention amongst the 3 groups - Femoral nerve block group: 5.00±1.75 vs IV Fentanyl group: 3.7±1.66 vs IV Low dose IV Ketamine group: 4.65±1.35 with p = 0.035 which was significant (p 0.05 was considered significant). VAS score difference of before/after was significantly less in Group B, or higher outcome (pre-post difference of VAS score) was observed in Group A, followed by Group C. The number of patients whose VAS score after 10 min came down to  3, corresponding to mild pain in the VAS strata: 11(55%) in FNB group vs 10(50%) in IV Fentanyl group vs 15 (75%) in IV Low dose Ketamine group. The number of patients with VAS score 3, 10 minutes after the intervention were higher in Group C, followed by Group A and Group B. Though the pre/post VAS score difference and the separate mean VAS score at 10 mts was significantly low in the FNB group compared to the other groups, the total no of patients with a VAS score of 3, 10 minutes after the intervention were more in the IV low dose ketamine group.

Conclusion: Femoral nerve block with 1% lignocaine appeared to provide better analgesia than IV fentanyl and IV low dose ketamine for positioning for central neuraxial block in patients with lower limb fractures. However, IV low dose ketamine appears to alter the pain scores to clinically comfortable levels for the patient in a quick and non-invasive way.

Rapid onset of sensory block and prolonged postoperative analgesia with haemodynamic stability without neuro and cardiotoxicity are important goals in regional anaesthesia. Axillary block is the most distal block performed on the brachial plexus (except for single nerve blocks in the arm and forearm). Because of its distal location, the axillary block have negligible risks of the respiratory compromise secondary to pneumothorax or phrenic nerve blockade. In addition, the peripheral location permits adequate arterial tamponade to be apllied if an advertent puncture occurs. This study was conducted on 80 patients of ASA I & II and were randomly allocated in two groups receiving two different concentrations of ropivacaine through axillary approach. Onset and duration of sensory and motor block was observed, patients with partial or incomplete block were managed accordingly by supplementing sedatives and analgesics. The rate of complete sensory and motor block was higher in both groups at 10, 15 and 20 mins. Onset of sensory bock in group I and II was 18.48±1.52 mins and 18.88±1.45 mins. Onset of motor block in both groups was 19.48±3.84 mins and 20.56±3.78 mins. No significant stastistical differences were observed with different concentrations of ropivacaine, hence it can be concluded that higher concentration does not have additional benefits, both concentrations were found equally good and potent.

Introduction: The risk of apnea after surgery is significant in neonates regardless of anaesthetic agents used. A prospective randomized study done at our institute to explore the hypothesis “post-operative neonatal recovery is better with sevoflurane and caudal block with spontaneous ventilation compared to a technique with muscle relaxants.”

Aim: To study neonatal recovery after sevoflurane and caudal block with spontaneous ventilation in comparison with the addition of Muscle relaxants.

Materials and Methods: Study done in 100 term neonates, undergoing emergency colostomy were studied for a period of 2 years. Group I patients induced and intubated with sevoflurane maintained spontaneous ventilation. Group II patients induction and intubation by sevoflurane and atracurium. Caudal block given in both groups with 1.25ml/kg volume of bupivacaine. Blinded observers recorded emergence timings and monitored postoperative apnea for 12 hours.

Results: Statistically no significant difference in the vital parameters recorded intraoperatively and post-operatively between the 2 groups. Median value of EtCO2 was different with p value < 0.05. Median time to first movement, eye opening, tracheal extubation and first cry was less in group I (150, 150, 180, 210 seconds) than in group II (300, 330, 360 and 420 seconds). Post-operative incidence of apnea is lesser in group I (3/50) than group 2 (11/50), Chi-square static is 6.3529. p value is 0.012 (<0.05). No rescue airway interventions were required in both groups.

Conclusion: Post-operative apnoeic spells are less and neonates wake faster with sevoflurane and caudal block with spontaneous ventilation compared to muscle relaxant group with IPPV. Sevoflurane and caudal block with spontaneous ventilation is preferable to other techniques for newborn lower abdominal surgeries.

Epidural block is the procedure to block the nerve roots outside the dura. It is the method providing analgesia, reflex flaccidity to muscles, degree of hypotension and ischemia secondary to sympathetic blockade while allowing spontaneous respiration to continue relatively unimpaired. This study was done to observe the onset and duration of sensory and motor block and duration of postoperative analgesia. The study was conducted on 90 indoor patients of either sex belonging to ASA-I & ASA-II, aged 20-70 years scheduled for lower abdominal or lower limb surgery, were randomly allocated in 3 groups of 30 patients each. Group 1 received Epidural block with lignocaine and adrenaline 1.5%, Group 2- Epidural block with bupivacaine 0.375% and Group 3 received Epidural block with lignocaine and bupivacaine mixture in ratio of 1:1. Patients were premedicated with Atropine 0.6 mg, Midazolam 2mg and Pentazocine 30mg intravenously after the epidural block was achieved. They were monitored for pulse rate, respiratory rate, blood pressure, onset of sensory loss, motor paralysis and total duration of sensory and motor block. The onset of sensory (11.9±3.16mins) and motor block (13.2±2.1mins)was earliest in group I and duration of block (261±76mins) was longest in group II

Background: Providing anaesthesia in prone position is a challenging task for an anaesthesiologist. Although the favourable technique of airway management has been endotracheal tube (ETT), alternative airway management with Laryngeal Mask Airway (LMA) has also been described. In the present study we compared use of LMA and ETT for surgeries in prone position.

Material and Method: Study includes prospective analysis of 60 patients who underwent prone surgeries and were randomly divided into two groups of 30 each. Group I (LMA) - Patients underwent prone surgeries with classic LMA on spontaneous ventilation Group II (ETT) -Patients underwent prone surgeries with ETT under controlled ventilation. Time from induction of anaesthesia to start of surgery, time of recovery from anaesthesia after completion of surgery, number of complications and the haemodynamic parameters were recorded.

Results: We observed significant reduction in induction to start of surgery time as well as recovery time in Group I (LMA) as compared to Group II (ETT) which results in decreased anaesthetic exposure duration in group I. There was better haemodynamic stability in Group I (LMA) as compared to Group II (ETT) along with marginal reduction (statistically non significant) in frequency of complications.

Conclusion: LMA minimizes the total time duration of anaesthesia during prone surgeries with better haemodynamic stability.