European Journal of Molecular & Clinical Medicine

To compare the effects of intrathecal Bupivacaine-Fentanyl (25 µg) combination with that of intrathecal Bupivacaine-Saline combination in patients undergoing Appendicectomy under spinal anaesthesia with regard to, Characteristics of sensory block, Duration of motor block, Quality of surgical anaesthesia, Haemodynamic and respiratory changes, Adverse Effects, if any.
Methods: A total of 60 patients aged between 20 to 40 years of either sex belonging to ASA Grade I & II posted for elective Appendicectomy under Spinal Anaesthesia were selected randomly for the study during the period starting from December 2021 to November 2022, at Department of Anesthesia & Critical Care, Dr B.R Ambedkar Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India. The Study was approved by the Hospital Ethical Committee.
Results: The incidence of intraoperative complications was compared in both the groups. The addition of Fentanyl to intrathecal Bupivacaine did not produce any significant cardiovascular changes (Bradycardia, Hypotension). Respiratory depression was not observed in either of the groups. Nausea & vomiting was seen in 16.6% of the patients in group BS as compared to 3.5% in Group BF. The incidence of pruritus was higher in Group BF but none of the patients required any medication. Postoperative analgesia was assessed by the VNRS score. A significantly lower VNRS score (superior pain relief) was observed in Group BF with average duration of analgesia being 5 hours. The patients were followed up for 24 hours and showed no neurological sequelae.
Conclusion: We conclude that the addition of 25mg of preservative free Fentanyl to hyperbaric Bupivacaine administered intrathecally to a patient undergoing Appendicectomy provides improved quality of surgical anaesthesia, haemodynamic stability and significant post- operative analgesia with minimal side effects. However, the study needs to be conducted on a larger population for further evaluation

The provision of adequate analgesia is necessary after any surgery and is all the more important in children. Pain after surgery is inevitable. It has been recognized for some time that management of acute pain, especially postoperative pain, has been consistently and systematically inadequate, situation being worse in children.
Methodology: After careful pre-anaesthetic check-up children posted for elective sub-umbilical surgeries between age groups of 3-8yrs of ASA I & II were randomly divided into 2 equal groups. Group L received levobupivacaine 0.25% 1ml/kg + 2mcg/kg clonidine and Group R received ropivacaine 0.25% 1ml/kg + 2mcg/kg clonidine. Following intrathecal administration of these drugs, intraoperative hemodynamic changes, postoperative pain relieving quality and rescue analgesia were studied. Hemodynamic parameters were monitored in the intraoperative and postoperative period. Incidence of side effects were also noted.
Conclusion: Addition of clonidine as an adjuvant to both the groups were significantly increase in Post-operative analgesic quality with perioperative hemodynamic stability with minimum side effects. Thus making it evident the clonidine as an adjuvant to Ropivacaine and levobupivacaine can be safely used for single shot caudal block in children undergoing elective subumbilical surgeries.

Birth plans have received a positive response in most developed countries as a way to bridge gaps and enhance relationships between the subject and the care giver, but in some countries, they have been subjected to skepticism as it led to friction between the doctor and the subject. In India educational status is a great determinant of child birth planning. Most women lack formal education about process of delivery, its risks and complications, hence, in Indian scenario birth plans are still a neo entity. This study was conducted in order to assess awareness of birth plan in Indian women, awareness regarding the process of child birth, the mother’s preferences and choices regarding mode of delivery, and patient satisfaction post-delivery.
Methods: A questionnaire was developed that assessed parameters such as educational status, parity and awareness of birth plan in women in their third trimester attending the antenatal clinic and a post-partum questionnaire was administered within 2 weeks of birth or at post-partum visit. Patient satisfaction was then assessed based on the data collected.
Results: A total of 220 women completed the questionnaire, of which 1.4 per cent (n=3) were aware about a birth plan while the others (n=217) which included women from all strata of society and varying education levels, had no awareness of the concept of a birth plan. Although 98.6% of women were unaware of a birth plan most (77.3%) opted for a vaginal delivery and 22.7% opted for an elective cesarean section. While all the women (100%) requested for any form of pain relief intra and post-partum, only 87.7% (n=193) were satisfied with the pain relief they received. Women whose mode of delivery was as planned reported higher satisfaction rates. Overall 88.01% women (n=194) who were not aware of birth plan still had positive satisfactory childbirth experience while 11.98% (n=26) reported negative experience.
Conclusions: Though 50.50% of women in the study were educated up to higher secondary level only 1.4% were aware of the concept of a birth plan. Hence, education is not a sole determinant in the lack of awareness of planning for a birth. Other determinants that seemed to play a role in the mother’s satisfaction rates were mode of delivery, management of labour and post-partum analgesia and cultural beliefs such as sex of the child.

Aim: To compare the effectiveness of post caesarean section pain relief between transversus abdominis plane block and conventional parenteral opioid analgesia by comparing visual analogue pain scores.
Material and methods: The current study is a prospective randomized interventional studyobservational study. The study was conducted over the period of DNB training for a period of three years. Total 100 patients of American Society of Anesthesiologists (ASA) Grade I and II aged 18 - 45 years scheduled to undergo lower segment caesarean section under spinal anesthesia were included in this study.
Results: It is observed that to compare the effectiveness of post caesarean section pain relief between ultrasound guided transversus abdominis plane block and conventional parenteral opioid analgesia by comparing visual analogue pain scores and total opioid consumption in 24 hours. A total of 100 patients, 50 in each group were included. The distribution of patients according to age between the groups. The mean age of patients of TAP and CONT groups was 25.62±2.19 and 25.64±2.31 years respectively. There was no significant (p>0.05) difference in age between the groups showing comparability of the groups in terms of age. Additionally, the distribution of patients according to ASA grade between the groups. More than half patients of both TAP (74%) and CONT (72%) group had ASA grade I.
Conclusion:This study was carried out to adding transversus abdominis plane block as a part of multimodal analgesia in patients undergoing caesarean section prolonged pain- free duration, decreased VAS pain scores, reduced the number of patients who required rescue analgesicamount of rescue analgesia required was much less in amount and prolonged the time to first request for analgesia.

Regional anaesthesia has been preferred over general anaesthesia in many orthopaedic surgeries due to lack of associated complications in regional blocks. Increasing the duration of local anaesthetic action can obtain the desired effect of prolongation of the postoperative patient comfort. Many adjuvants to local anaesthetics such as epinephrine, clonidine, opioids, dexmedetomidine and also neostigmine have been tried. Recently, dexamethasone has been found to prolong postoperative analgesia, reducing the requirement of the local anaesthetic and also the side effect profile. Hence our study was conducted to analyse the efficacy of dexamethasone as an adjuvant drug to levobupivacaine. After institutional ethical committee approval, CTRI registration and patient consent, a double blinded randomised controlled study was conducted in 50 patients aged 18-65 years of ASA I&II undergoing upper limb surgeries distal to mid-humeral level over a period of 1year. The mean duration of post-operative analgesia in Group D was 1022.2±62.67 minutes and in Group S was 777.40±34.19 minutes (p<0.001). The mean total dose of rescue analgesics required was more in Group S when compared to Group D in the first 24hrs. The onset of sensory and motor block was faster in Group D when compared to Group S. The mean duration of sensory and motor block was significantly longer in Group D than Group S. The addition of dexamethasone to levobupivacaine in SCBP blockade was associated with faster onset as well as prolonged duration of sensory and motor block, prolonged duration of post-operative analgesia and required less rescue analgesics.

Regional anaesthesia has been preferred over general anaesthesia in many orthopaedic surgeries due to lack of associated complications in regional blocks. Increasing the duration of local anaesthetic action can obtain the desired effect of prolongation of the postoperative patient comfort. Many adjuvants to local anaesthetics such as epinephrine, clonidine, opioids, dexmedetomidine and also neostigmine have been tried. Recently, dexamethasone has been found to prolong postoperative analgesia, reducing the requirement of the local anaesthetic and also the side effect profile. Hence our study was conducted to analyse the efficacy of dexamethasone as an adjuvant drug to levobupivacaine. After institutional ethical committee approval, CTRI registration and patient consent, a double blinded randomised controlled study was conducted in 50 patients aged 18-65 years of ASA I&II undergoing upper limb surgeries distal to mid-humeral level over a period of 1year. The mean duration of postoperative analgesia in Group D was 1022.2±62.67 minutes and in Group S was 777.40±34.19 minutes (p<0.001). The mean total dose of rescue analgesics required was more in Group S when compared to Group D in the first 24hrs. The onset of sensory and motor block was faster in Group D when compared to Group S. The mean duration of sensory and motor block was significantly longer in Group D than Group S. The addition of dexamethasone to levobupivacaine in SCBP blockade was associated with faster onset as well as prolonged duration of sensory and motor block, prolonged duration of post-operative analgesia and required less rescue analgesics.

Nociceptive pain is often regarded as the key feature of acute post- operative pain. Laparotomy is a major surgical procedure which is associated with substantial post operative discomfort and moderate to severe pain postoperatively. Aims: This prospective observational study was undertaken to compare the analgesic effect of TAP block and Local infiltration of incision site in patients undergoing laparotomy. Materials and Methods: 100 patients of ASAI and ASAII undergoing laparotomy were enrolled for the study to receive either TAP block with 40ml of 0.2% Ropivacaine (20ml on each side) or local infiltration with 40ml of 0.2%  Ropivacaine around the wound. Patient’s VAS score, requirement for rescue analgesia, hemodynamic parameters and any side effects were noted for 48 hours. Results: Patients receiving TAP block had significantly lower VAS scores and requirement for rescue analgesia. However the hemodynamic parameters and side effects were comparable between the 2 groups. Conclusion: TAP block is significantly better for analgesia in patients undergoing laparotomy compared to local infiltration in the setting of a multimodal analgesic regimen without increasing the side effects.

To compare the efficacy of epidural FENTANYL and TRAMADOL for post-operative analgesia in lower limb surgeries in terms of onset of analgesia, duration of analgesia, quality of analgesia and undesirable effect.
Material Method: This prospective randomized study was conducted to compare the analgesic efficacy and side effects of epidural fentanyl and that of epidural tramadol and included sixty (60) patients of either sex in the age range of 18-65 years, undergoing lower limb surgeries under Combined Spinal Epidural anaesthesia (CSE) with ASA physical status I & II. These were divided into two groups of 30 patients each. Group F- Fentanyl group and Group T- Tramadol group. Patients of Group F received 50 mcg of Fentanyl + 8ml of 0.125% Bupivacaine (9 ml) and that of Group T received 50 mg of Tramadol and 8ml of 0.125% Bupivacaine(9 ml).The patients were randomly given epidural fentanyl or epidural tramadol when patient complained of pain post operatively with Visual analog score 3 or above. Patients were closely monitored in the post-operative period till they had pain relief. Quality of pain relief was measured using visual analogue scale and occurrence of side effects like nausea and vomiting, pruritis, respiratory depression were noted.A detailed clinical history and physical examination of the patients was done and all vital parameters were recorded well in advance. An informed and written consent was taken from the patient for the study.
Result: Mean Time of onset of analgesia after epidural injection was 5.42 ± 1.18 minutes in Group F and 12.80 ± 1.62 minutes in Group T and the difference was found to be statistically significant. Mean Duration of analgesia was 240.22 ± 36.53 in Fentanyl group and 360.52 ± 24.83 in Tramadol groups respectively which was also statistically significant. Pruritis was significantly higher in Fentanyl group whereas nausea and vomiting was higher in tramadol group. Quality of analgesia was better following administration of epidural Fentanyl.
Conclusion: Both epidural Fentanyl and Tramadol are effective in relieving post-operative pain; however Fentanyl produced better patient satisfaction compared to tramadol but the duration of action was short.

Background & Objective - This study aimed to compare efficacy of nalbuphine and fentanyl as adjuvant to bupivacaine in providing intra-operative anesthesia and post-operative analgesia in lower limb orthopedic surgeries, and to compare the characteristic of sensory and motor block, hemodynamic parameter, time of first rescue analgesia and adverse effects between two groups.
Method- In this clinical trial, 80 patients undergoing elective lower limb orthopedic surgeries under spinal anesthesia were randomly allocated in two groups. In group BN, the patients received 0.5% 3ml (Heavy Bupivacaine + 800 mcg Nalbuphine. In group BF patients received 0.5% 3ml (Heavy Bupivacaine + 25mcg Fentanyl.
Result & interpretation- The Onset of motor block, maximum level of block and time to reach peak level of block was significantly faster in group BF.While duration of motor block and time for first rescue analgesia was significantly prolonged in BN group. However, there was no significant difference in time for two segment regression=0.157 (NS) and hemodynamic changes.
Conclusion- We conclude that combination of fentanyl as adjuvant to bupivacaine provides higher segmental level sensory blockage, faster sensory and motor blockage than nalbuphine. But nalbuphine gives longer time of post-operative analgesia than fentanyl.

Since pain has been reported to occur in 25%–40% of patients treated for endodontics procedure, it is a major concern for dentists and their patients. Hence in dentistry, nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed to treat pain and swelling. The most frequently used of these medications are ibuprofen and paracetamol. They work by inhibiting the enzyme cyclooxygenase, which then prevents the production of prostaglandins. All of these medications exhibit a comparable mode of action, which causes them to have comparable side effects. The present article reviews the knowledge currently available on NSAIDs with a focus on dental practice-related elements

Background: Supraclavicular approach of brachial plexus block has been popular technique in delivery of anesthesia in patients undergoing upper limb surgeries. Of various local anesthetics, bupivacaine is used most frequently for brachial plexus block. Any adjuvant to the local anesthetics for brachial plexus block prolongs its analgesic effect. Hence the present study was undertaken to compare the effect of dexmedetomidine and fentanyl as adjuvant to bupivacaine in supraclavicular nerve block for upper limb surgeries. Methods: A total 100 patients of ASA grade I and II were enrolled and randomly divided into two equal groups. Group A received 25-30mL of 0.5% Bupivacaine + 50μg Fentanyl and group B received 25-30mL of 0.5% Bupivacaine + 50μg Dexmedetomidine. The onset time and duration of sensory and motor blockade were recorded. Hemodynamic variables and duration of analgesia were recorded for 24 hours postoperatively. Results: The onset of sensory and motor block was significantly faster, and duration of sensory and motor block was significantly prolonged in group B as compared to group A (p<0.05). Rescue analgesic requirements were significantly less in group B compared to group A (p<0.05). Hemodynamic variables did not differ between groups in the post-operative period, except the pulse rate which was found to be on the higher side for fentanyl group. Conclusion: Addition of 50μg dexmedetomidine to 25-30ml bupivacaine 0.5% in supraclavicular brachial plexus block was more effective in prolongation of sensory and motor duration as well as providing adequate intra-operative analgesia when compared to 50μg fentanyl with 25-30ml bupivacaine 0.5%, without producing any adverse events.

Introduction: The effective intrapartum analgesia greatly minimizes pain, stress, and anxiety which cause release of stress hormones as well as beta-endorphins. This this present study is followed to evaluate the effect of intrathecal labour analgesia on the progress of labour was compared between fentanyl 25μg alone and fentanyl 20μg plus bupivacaine 2.5mg. Materials and Methodology: Patients in the group SA (n = 33) were administered with an intrathecal injection of 0.5% hyperbaric bupivacaine 2.5 mg (0.5 mL) and fentanyl 25 µg (0.5 mL), volume made to 1.5 mL with normal saline. And the matching group C (n = 33) who refused to give consent for neuraxial analgesia. The two groups were evaluated with regards to the progress of labour, maternal hemodynamic variations, foetal heart rate, and neonatal outcome during labour in parturient undergoing normal vaginal delivery. Results: Parturient in group SA has gained excellent pain relief throughout their labour and VAS score remained less than 4 till delivery as compared to group C, in which VAS score was more than 7 at all time. There were no observed significant changes in FHR when compared to the baseline in both the groups and none had observed with the interventions of foetal compromise. The mode of delivery in all parturient in the study group was mostly vaginal delivery without any instrumental delivery. The parturient who required caesarean section due to other indication were excluded from the study. Conclusion: A a single dose of intrathecal fentanyl 25 μg and bupivacaine 25 mg which were given in the active phase of first stage of labour had rapid onset with satisfactory pain relief and minimal motor block, which completely regressed at the time of second stage of labour.

Background and objectives: The provision of adequate analgesia is necessary after any surgery and is all the more important in children. Pain after surgery is inevitable. It has been recognized for some time that management of acute pain, especially postoperative pain, has been consistently and systematically inadequate, situation being worse in children. Bupivacaine has been for long used in caudal for post-operative analgesia but had back drop considerations of toxicity in large doses thus making it necessary to be able to use an alternative drug like Ropivacaine and levobupivacaine with lower toxicity but similar analgesic capability.
Methodology: After careful pre-anaesthetic check-up children posted for elective sub-umbilical surgeries between age groups of 3-8yrs of ASA I & II were randomly divided into 2 equal groups. Group L received levobupivacaine 0.25% 1ml/kg + 2mcg/kg clonidine and Group R received ropivacaine 0.25% 1ml/kg + 2mcg/kg clonidine. Following intrathecal administration of these drugs, intraoperative hemodynamic changes, postoperative pain relieving quality and rescue analgesia were studied. Hemodynamic parameters were monitored in the intraoperative and postoperative period. Incidence of side effects were also noted. Conclusion: we noted that Addition of clonidine as an adjuvant to both the groups were significantly increase in Post-operative analgesic quality with perioperative hemodynamic stability with minimum side effects. Thus making it evident the clonidine as an adjuvant to Ropivacaine and levobupivacaine can be safely used for single shot caudal block in children undergoing elective subumbilical surgeries.

Aim: The purpose of the present study was to assess the efficacy of fentanyl transdermal patch in case of impacted mandibular third molar surgery.
Methodology: 20 patients within the age group of 18–40 years with asymptomatic impacted mandibular third molars were equally divided into 2 groups as group A & group B which underwent surgery in Local Anaesthesia. In every patient one side belonged to group A and other side belonged to group B. 50 μg FTS was applied in group A while placebo patch was applied in group B.
Results: Patients in group A performed significantly better than group B in terms of mean pain intensity scores assessed by VAS and VRS along with minimum need of post-operative rescue analgesics.
Conclusion: It was found that FTS resulted in significantly better pain relief, longer pain-free intervals, and lesser post-operative analgesic consumption.

Treating pain in the newborn is essential for many reasons: pain can be harmful due to decreased oxygenation, hemodynamic instability, and increased intracranial pressure.The International Evidence-Based Group for Neonatal Pain recommends that the combination of a variety of pharmacological and behavioral interventions during painful procedures has synergistic effects. Data were collected duringheel lance and venipuncture performed as part of routine clinical care for the estimation of glucose and bilirubin,thyroid function tests respectively. The infants in the control group (n=64) received 10% dextrose. In the experimental group, 24% sucrose solution was used. When compared to 10% dextrose, no. of babies who received sucrose and fall into NIPS score <4 category at 1 min and 3 min during the procedure were more. Hence 24% sucrose has better analgesic effect than 10% dextrose. However statistically when Fischer exact test was applied between the groups there were no significant differences between 24% sucrose and 10% dextrose.

Background: The erector spinae plane (ESP) blockade acts as a potent unilateral analgesic technique. The block is performed by injecting local anaesthetic drug in the plane between the erector spinae muscle and the vertebral transverse process, with its effect due to diffusion of the local anaesthetic into the paravertebral space through spaces between the adjacent vertebrae. It is a relatively safe and easy technique as compared to the thoracic epidural because our target in ESP blockade is the transverse process, which is identified easily and is distant from neural or major vascular structures and the pleura. Aim of the study: To assess the analgesic effect of ultrasound guided unilateral erector spinae blockade in open cholecystectomy Material and methods:We present a case series of ESP blockade under ultrasound guidance in nine patients scheduled for open cholecystectomy because surgeons chose to avoid laparoscopic surgery due to the increased risk of COVID-19 infection due to intraperitoneal aerosol generation. Results: All patients with postoperative ESP blockade maintained an NRS pain score of 03/10 for 24 h, except for those requiring emergency analgesia. The pain relief was excellent in all our patients and there were no complaints of nausea, vomiting. Conclusion: ESP blockade is proving to be a successful technique for intraoperative and postoperative analgesia.

Background: Caudal blocks have been shown to reliably block dermatomes below the level of the umbilicus (T10–S5) in children <20 kg (∼6 yr of age).  Caudal epidural anaesthesia involves accessing the epidural space through the sacrococcygeal ligament via the sacral hiatus at the base of the sacrum. The aim of this study was to compare the effects of ropivacaine and bupivacaine for caudal anaesthesia in children undergoing lower abdominal surgery.
Methods: After the hospital ethics committee approval, 60 (ASA I–II) children scheduled for lower abdominal surgery were included in this study. The group A (n=30) patients received ropivacaine 0.25% and group B (n = 30) patients received bupivacaine 0.25% via the caudal route. In this study we assessed demographic and clinical characteristics, AIIMS pain score at 1, 2, 4, 8, 12, 16 and 24 hours after operation and level of residual motor block (Modified Bromage Scale) immediately after surgery and at 1, 2 and 3 hours post operatively.
Results: There were no statistically significant differences in AIIMS pain scores between groups A and B at all postoperative time points – 1hr, 2hr, 4hr, 8hr, 12hr, 16hr and 24hr (P < 0.00001). The quality and duration of analgesia were comparable in both the groups. However, degree of motor block was significantly less in the ropivacaine group. After 3 hours there was no significant difference in the level of residual motor block.
Conclusion: The single shot caudal epidural block with 1ml/kg ropivacaine 0.25% is a safe and effective, long lasting dose for postoperative analgesia in paediatric lower abdominal surgery, producing less duration of motor block than bupivacaine 0.25%.

Background: Caudal epidural anaesthesia blocks dermatomes below the level of the umbilicus  in children.
Objectives:This study intends to compareropivacaine and bupivacaine for caudal anaesthesia in children undergoing lower abdominal surgery.
Materials and methods: After the hospital ethics committee approval, 60 (ASA I–II) children scheduled for lower abdominal surgery were included in this study. Group A (n=30) patients received ropivacaine 0.25% and group B (n = 30) patients received bupivacaine 0.25% via the caudal route. We assessed the demographic and clinical characteristics, AIIMS pain score at 1, 2, 4, 8, 12, 16 and 24 hours after operation and level of residual motor block (Bromage Scale)immediately after surgery and at 1, 2 and 3 hours post operatively.Data analysis was performed using one way ANOVA test.P value less than 0.05 was considered significant.
Results and conclusion: There were no statistically significant differences in AIIMS pain scores between groups A and B at all postoperative time points –1hr, 2hr, 4hr, 8hr, 12hr, 16hr and 24hr(P < 0.00001). The quality and duration of analgesia were comparable in both the groups. However, degree of motor block was significantly less in the ropivacaine group. After 3 hours there was no significant difference in the level of residual motor block.
The single shot caudal epidural block with 1ml/kg ropivacaine 0.25% is a safe and effective, long lasting dose for postoperative analgesia in paediatric lower abdominal surgery, producing less duration of motor block than bupivacaine 0.25%.

Background: Opioids and local anaesthetics act synergistically and it’s a popular technique to combine bupivacaine and fentanyl in spinal anaesthesia for caesarean delivery. The aim of the study was to find out optimal dose combination of bupivacaine and fentanyl for spinal anaesthesia for better quality of perioperative analgesia and reduction of feto-maternal adverse outcome during caesarean section.
Methods: Three hundred and four parturients scheduled for caesarean delivery were randomly allocated to four groups of 76 each. Data of 298 parturients (Gp I=73, Gp II=75, Gp III=75 and GP IV=75) was included in the primary outcome analysis. The control group received 12 mg of 0.5% hyperbaric bupivacaine for spinal anaesthesia. Fentanyl 15, 20 or 25 μg was added to each study group who received 9 mg of 0.5% hyperbaric bupivacaine in spinal anaesthesia. Onset and duration of spinal anaesthesia, hemodynamic parameters, intraoperative nausea & vomiting (IONV), failed block, APGAR score and other side effects were noted.
Results: The duration of effective and complete analgesia was significantly longer in all fentanyl groups. However, increasing the dose of fentanyl from 15 to 25 μg had little effect on further prolongation of analgesia. Duration of motor blockade was significantly prolonged in control group. The incidence of hypotension and IONV episodes were significantly low in the study groups.
Conclusion: Bupivacaine and fentanyl have super additive effect in spinal block. However, strict drug dose calculation is required in spinal anaesthesia to minimize adverse outcomes during caesarean delivery. Spinal anaesthesia with fentanyl 15 μg and 0.5% hyperbaric bupivacaine, 9 mg provides optimal surgical conditions for caesarean delivery with negligible side effects as compared to other dose combinations.

Background:Hyperbaric bupivacaine 0.5% (l0mg) with fentanyl 15mcg(0.3ml) and (2)
Hyperbaric bupivacaine 0.5% (10mg) with clonidine 45mcg. Objectives: The study
compared the onset and duration of action of intrathecal hyperbaric bupivacaine 0.5
percent and fentanyl 15mcg (group-I) to intrathecal hyperbaric bupivacaine 0.5 percent
and clonidine 45 mcg (group-II) in spinal anaesthesia in LSCS. The combination of
bupivacaine with fentanyl or clonidine assists anesthesiologists in alleviating
intraoperative discomfort by delivering superior analgesia to patients without extending
recovery.
Materials and Methods: The study included 80 female patients with ASA grade I (n=40
in each group). The time of onset of sensory and motor block, duration of analgesia, 2-
segment regression, intraoperative discomfort, hemodynamic stability, time to
micturition, visual analogue score, and postoperative analgesic requirements were all
evaluated.
Results: In group II, the onset of sensory and motor block was substantially later than
in group I (p0.001). Hemodynamic alterations did not differ between groups (p>0.05).
Intraoperatively, 1 patient reported pruritis, and 2 patients had postoperative urinary
II78.506.12min and groupII-—121.284.09 min) and regression of sensory level to L2
dermatome (group-I - 142.206.73 min and group II 166.405.79 min) were significantly
longer in group II (p0.001). The duration of analgesia in group II was 210.186.79
minutes, whereas in group II it was 323.5610.53 minutes, which is significant (p0.001).
The VAS scores in group II were considerably lower after 3 hours (p0.05), 6 hours
(p0.001), and 12hours (p0.001).
Conclusion: The addition of intrathecal clonidine 45 mcg to hyperbaric bupivacaine in
spinal anaesthesia gives greater analgesia with less perioperative discomfort, a longer
duration of analgesia, and a reduction in postoperative analgesic requirements.

Background: This study compared the analgesic efficacy of the bilateral erector spinae plane
(ESP) with that of the bilateral transversus abdominis (TAP) postoperative delivery with
selected surgery.
Methods: Sixty mothers scheduled for caesarean section under random surgery were
randomly assigned to receive an ESP block or a TAP block. The ESP group received USG
guided block with 20 mL 0.2% of ropivacaine at the T9 level corresponding to T10 transverse
process e at the end of surgery. The TAP group received an ultrasound-guided TAP block
containing 20 mL of 0.2% ropivacaine at the end of delivery. The main effect was the
duration of analgesia achieved by each block. Measures of the second outcome were
postoperative pain severity, complete diclofenac use, patient satisfaction.
Results: The median duration (interquartile) block was longer in the ESP group than in the
TAP group (12 hours [10-14] vs 8 hours [8-10], p <0.0001). In the first 24 hours, the median
rate of analog pain observed at rest was lower in the ESP group. Intermediate diclofenac use
in the first 24 hours was significantly higher in the TAP group than in the ESP group (125 mg
[100-150] vs 100 mg [75-100, p = 0.003]).
Conclusion: Compared with the TAP block, ESP block provides effective pain relief, has a
long lasting analgesic action, increases duration of first analgesic need, is associated with
minimal diclofenac use, and can be used in multimodal analgesia and opioid -sparing
medication after surgery.

Background: Pain management following caesarean section still remains a challenge in our
environment. Diclofenac suppository is an effective adjunct analgesic for post-operative pain
control. Over the last two decades the number of caesareans being performed has increased
dramatically. High quality postoperative analgesia is important because the new mother has
to recover from major intra-abdominal surgery while also caring for her newborn baby. Many
options are available but tailoring the method to the individual can be problematic because it
has been difficult to predict the severity of postoperative pain or the individual response to a
regimen.

Background: The present study was undertaken for assessing the efficacy of paracetamol in controlling analgesia during labour.
Materials &Methods: A total of 50 pregnant subjects were enrolled. All the subjects were broadly divided into two study groups, with 25 patients in each group, as follows: Group A: Patients received IV Paracetamol, and Group B: Patients received matched placebo.  The course of events was studied and decrease in intensity of pain if any during labour was accessed by visual analog score and fetal outcome (i.e., notice Respiratory, APGAR score at 1 min to 5 min after birth). The VAS consists of a 10-cm horizontal line anchored at one end with the words “no pain” and at the other end with the words “worst pain imaginable.” All the results were recorded in Microsoft excel sheet and were analysed by SPSS software. Chi-square test and student t test was used for evaluation of level of significance.
Results: Mean VAS after 30 minutes among subjects of Group A and Group B was 6.25 and 7.13 respectively. Significant results were obtained while comparing mean VAS after 30 minutes among subjects of the study group and the control group. Mean VAS after 60 minutes among subjects of Group A and Group B was 6.12 and 7.96 respectively. Significant results were obtained while comparing mean VAS after 60 minutes among subjects of the study group and the control group.
Conclusion: Intravenous infusion of acetaminophen during labour assists in relieving labour pain without any maternal and fetal adverse effects.

Introduction: Adequate pain control remains a major challenge after ambulatory surgery. Midazolam as adjunct to local anaesthetics in caudal epidural analgesia has been found effective with minimal adverse effects.
Objective: The study was carried out to evaluate the analgesic efficacy of caudal bupivacaine and midazolam in children undergoing genitourinary surgeryfor post operative analgesia and to study the side effects and complications of bupivacaine and midazolam.
Subjects and methods: Sixty children, aged2-12 were randomly selected from routine cases of pediatric genitourinary surgery in NSCB Medical college and Hospital, Jabalpur.Group B receive 0.25% bupivacaine 0.5ml/kg [n=30] and group BM receive combination of 0.25% bupivacaine 0.5ml/kg with 50 microgm/kg midazolam[n=30].Throughout the study period heart rate,arterial BP, respiratory rate were monitored. Postoperative pain was assessed by MODIFIED TODDLER PRESCHOOLER POST OPERATIVE PAIN SCALE [TPPPS].Rescue analgesia was given when pain score was 4 or more than 4. Sedation was evaluated by four point sedation score.
Results: Lowest pain score were observed in BM group. The mean duration of postoperative analgesia in group  B was 7.6+1.5hrs and in group BM was 10.43+0.95 hrs’ which was statistically significant[p<0.05]. There was no significant changes in HR,BP and respiratory rate in both groups. The incidence of nausea and vomiting were equal in both groups. No respiratory depression,motor paralysis or urinary retention in both groups during the period of study.
Conclusion- Caudal administration of bupivacaine , midazolam mixture prolongs postoperative analgesia compare to bupivacaine alone without causing any adverse effects and complications.

Elderly person of 80 years of age and older presents a specific challenge to anesthetists,
who needs toacquire and maintain skill and expertise in the management of such patients.
Departments should havea lead clinician with an interest in the care of the elderly.
Development in anesthesia and operative techniques hasconsiderably reduced morbidity
and mortality in the elderly patients.Several anesthetic techniques have been used for
elderly patientsincluding general anesthesia, regional anesthesia, intravenoussedation and
monitored anesthesia care. However, anesthesiarelatedmortality in these patients is still
high. All elderly patientsundergoing surgical procedures require a preprocedural
evaluationto assess the risks of anesthesia and procedure and to manageproblems related
to the preexisting medical conditions, monitoringpatients during intraprocedural and
postprocedural periods aswell as postprocedural management. This article considers
theage-related physiological changes, preprocedure assessmentand preparation, anesthetic
techniques, intraoperative care andpostoperative care. Age does not obtund the perception
of pain. Acute and chronic pain management teams should be available totreat the elderly.
Prophylaxis for Thrombo embolic disease should initiated to prevent further complications.