European Journal of Molecular & Clinical Medicine

Background: Labor epidural analgesia is an effective method of reducing pain during labor. For labour epidural, opioid sparing analgesia is gaining popularity.Opioidsparing drugs like dexmedetomidinehas been as an adjuvant to local anaesthetics with fewer side effects in various techniques and its less explored in labor epidural analgesia. Objective: To compare analgesic effects of dexmedetomidine and fentanyl when added to ropivacaine for labor epidural analgesia. Materials and methods: An observational comparative study was done after obtaining approval from ethicalcommittee(IEC/NMCH/15/02/2022_7), 60 nulliparous parturients were divided into 2 groups to receive either dexmedetomidine 0.5mcg/ ml with 0.2% ropivacaine (10 ml) or fentanyl 2mcg /ml with 0.2%ropivacaine 10ml.Onset and duration of sensory blockade was noted after giving first bolus. Results: The mean onset time of sensory-block in fentanyl group is higher thandexmedetomidine group. The duration of the sensory blockade showed a statisticallysignificant difference between the two study groups (p<0.05).There was significant alteration seen in hemodynamics between the study groups. No side effects were encountered in either group. Conclusion: Dexmedetomidineis superior to fentanyl as an adjuvant to ropivacainefor opioid sparing analgesia in labor epidural by providing longer duration of sensory blockade without any side effects.

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.

Introduction: Spinal anesthesia has been the choice of anesthesia for infraumblical surgeries. Aim: to evaluate the efficacy of adding clonidine (30µg) or dexmedetomidine (5µg) to 0.75% isobaric ropivacaine for administration of subarachnoid lumbar block in lower limb surgical procedures.
Methods: The Hospital based comparative, randomized, double blind, study was done on 120 patients (ASA grade 1-2) undergoing lower limb surgeries at S.M.S. Medical College and attached group of hospitals, Jaipur, after taking permission from the institutional ethical committee and review board. 120 patients were randomized into three groups of 40 each by sealed envelope method as follow: GROUP RS (0.75% Ropivacaine + 0.5 ml Isotonic saline), GROUP RC (0.75% Ropivacaine + 30µg Clonidine), GROUP RD (0.75% Ropivacaine + 5µg Dexmedetomidine).
Results: The mean time taken to achieve maximum sensory level was 18.40 minutes, 11.70mins and 18.80mins in groups RS, RC and RD, respectively (p<0.05). Mean time taken for sensory block to regress to L1 sensory level was 227.50minutes, 202.30minutes and 159.40minutes in groups RC, RD and RS, respectively(p<0.05). The time between the administration of subarachnoid block and request for rescue analgesic was 193.10 minutes, 347.60 minutes and 381.30 minutes in groups RS, RC and RD, respectively (p<0.05).
Conclusion: We conclude that both drugs, Clonidine and dexmedetomidine can be safely added as adjuvant to intrathecal Ropivacaine for lower limb surgeries, in view of similar sensory and motor block characteristics.

Significant postoperative discomfort is a side effect of total knee arthroplasty (TKA), which restricts postoperative movement, which is essential for restoring joint function. Pain is possibly the most dreaded thing in the world. It warns the body of illness. The intensity and length have an effect on quality of life. In orthopaedics, pain following total knee arthroplasty (TKA) is a major concern. Although continuous epidural analgesia and opioids continue to be the main options for postoperative pain treatment following TKA, they have negative side effects include drowsiness, nausea, and hypotension. An intricate and technically challenging technique requiring close monitoring is epidural catheterization. Local anaesthetic solution infiltration significantly reduces pain at the site. The learning curve is minimal, there are no long-term negative effects, no infections, no motor block at all, early mobilisation, and cost effectiveAn intricate and technically challenging technique requiring close monitoring is epidural catheterization. Local anaesthetic solution infiltration significantly reduces pain at the site. It has a minimal learning curve, no infection, no systemic side effects, no motor block at any level, early mobilisation, and is cost-effective. The use of ropivacaine and clonidine together as a LIA has not been extensively studied.
Methodology: At a tertiary care facility, a prospective study was conducted on 40 patients having total knee replacement surgery. A thorough evaluation of the airway, respiratory system, and cardiovascular system was done during the pre-anesthesia check-up. The simplest laboratory data were examined. The VAS was explained to patients, and it was assessed before surgery while the operated-on knee was at rest and while it was moving.
Results & Conclusion: The average age was 63.45 + 8.6 years, as we saw. Thirteen (32.5%) of the 40 patients were male, and 27 (67.5%) were female. In the first 24 hours following total knee replacement surgery, ropivacaine and clonidine have proven to be particularly efficient painkillers. We came to the conclusion that the need for opioid has diminished with the use of local infiltrative anaesthetic, or the combination of ropivacaine and clonidine. Tachycardia and hypertension effects on the cardiovascular system have also diminished. Early mobilisation also helped the patient, who benefited.

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.

Pain during the postoperative period has an impact on the quality of recovery and the length of hospital stay, which is a point of concern both for the surgeon and patients. Many modalities for reducing postoperative pain have been evaluated, with Lumbar paravertebral Block being associated with reduced postoperative pain, significantly reduced postoperative analgesic requirements.
Aim: The primary objective of the present study was to assess the analgesic effectiveness of Lumbar paravertebral block given with Ropivacaine alone and Ropivacaine with Dexamethasone (as adjuvant) for elective lower limb surgery.
Material and Methods: This was a single-centre, double blinded, hospital-based comparative observational study conducted among a total of 60 patients undergoing lower limb elective surgery given Lumbar paravertebral block given with Ropivacaine alone (30 patients) and Ropivacaine with Dexamethasone, as adjuvant (30 patients). Evaluation of Postoperative pain, with the first demand of analgesia and total analgesic required, was recorded.
Results: There was no statistically significant difference between the two groups regarding the distribution of age, weight, gender or BMI. The mean VAS score at 0,6, 12-, 24-, 36- and 48 hours after surgery among patients given lumbar paravertebral block with Ropivacaine alone was 0, 2.6, 4.1, 3.9 and 4.1, respectively. The mean VAS score at 0, 6, 12-, 24-, 36- and 48 hours after surgery among patients given Lumbar Paravertebral Block with Ropivacaine and Dexamethasone was 0, 1.1, 2.5, 3.4, and 3.6, respectively. The mean duration of the first request for analgesia was 14.6 hours and 19.2 hours among the patients given only Ropivacaine in comparison to those given both Ropivacaine + Dexamethasone (p<0.0001).
Conclusion: Lumbar paravertebral nerve block given with both Dexamethasone & Ropivacaine for elective lower limb orthopedic surgery improves postoperative analgesic quality and decreases the requirements of analgesia in comparison to patients given Ropivacaine alone.

Introduction: Regional Anaesthesia is the most common and preferred technique for elective inguinal hernia surgeries. The most commonly used anaesthetic agent for spinal anaesthesia are Lidocaine and Bupivacaine. Ropivacaine is an alternative to Bupivacaine due to its lesser degree and duration of motor blockade, good hemodynamical stability and lesser systemic toxicity. Hence this study was conducted to find out the efficacy and side effect profile of the Ropivacaine against the bupivacaine for elective inguinal surgery as part of day care surgery.
Material and Methods: This present study was a prospective study conducted at tertiary health care hospital on 80 patients undergoing elective inguinal hernia surgery divided into two groups, Group R – receives 3 ml of isobaric ropivacaine 0.5% with 0.5 ml of Fentanyl which contains 25 micrograms and Group B – receives 3 ml of hyperbaric bupivacaine 0.5% with 0.5 ml of fentanyl which contains 25 micrograms. Sensory and motor blockade were assessed along with duration and the analgesia

Caesarean section commonly induces moderate to severe pain lasting 48 hours after surgery. Prompt and adequate post-operative pain relief is an important component of caesarean delivery that can make the period immediately after the operation less uncomfortable as well as mother can initiate early breastfeeding that helps to contract the uterus and accelerates the process of uterine involution in the postpartum period. Various clinical studies have shown that ropivacaine is equal to bupivacaine in local anesthetic potency and is less toxic than bupivacaine in regard to the production of mild central nervous system and cardiovascular toxicity. Methodology- The study was carried out a tertiary care center on patients fulfilling the inclusion and exclusion criteria. Patients were randomly allocated in two groups i.e, Group A & Group B consisting of 50 patients in each. Spinal anaesthesia was performed at L3-L4 with 8–10 mg of a hyperbaric bupivacaine 5 mg/mL solution. Intraperitoneal instillation and incisional infiltration with 30 mL of 0.25% ropivacaine was performed in Group A. Intraperitoneal instillation and incisional infiltration with 30 mL of 0.25% ropivacaine plus epinephrine (5mics) (1:2,00,000) was given in Group B. The haemodynamic monitoring was done at every 15 mins in first hour of skin closure, in the recovery room, then at 2 hours, 4 hours, 6 hours, 8 hours, 12 hours and 24 hours after closure of the skin measuring heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and SPO2. Results- In both the groups, study drugs prolonged the duration of analgesia for similar duration in post-operative period. Hence, there is no difference between duration of analgesia provided by the study drugs post-operatively in both the groups and is statistically non-significant since p>0.05. Conclusion- 0.25% plain ropivacaine 30 ml and 0.25% Plain ropivacaine 30 ml plus epinephrine (1:2,00,000). Both given as intraperitoneal instillation and incisional infiltration, provide adequate post-operative analgesia for similar duration of hours.

Introduction: Ropivacaine, a newer long acting amide local anaesthetic and it has lesser side effects compared to Bupivacaine and is increasingly replacing Bupivacaine because of its similar analgesic profile and lesser cardiotoxicity. Tramadol hydrochloride is a weak centrally acting analgesic commonly used as adjuvant with local anaesthetic agents in epidural analgesia. Aims and objectives: The aim of this study was to compare the hemodynamic changes of 0.125% Bupivacaine with that of 0.125% Ropivacaine along with tramadol in patients undergoing intra abdominal surgery for post-operative analgesia. Material and Methods: Total 60 patients were taken scheduled for intra operative surgery ranging from 18-55 years in ASA grade I and II. They were randomly allocated to two groups of 30 each. Group R (n = 30) received an Epidural loading dose of 10ml 0.125% of Ropivacaine with 50mg tramadol. Group B (n =30) received an Epidural loading dose of 10ml 0.125% Bupivacaine with 50mg tramadol. Patients were assessed post-operatively every 15 min for heart rate, blood pressure, SPO2 for first hour and then after every 30 min till patient complained of pain. Result: Hemodynamically, patients in both the groups, were equally stable. Group-R (412 ± 46.56 min) was having much longer duration of post-operative analgesia as compared to Group-B (348 ± 48.31 min, p < 0.001). Conclusion: Ropivacaine and Bupivacaine shows a similar hemodynamic profile. Thus, Ropivacaine can be used as an alternative to Bupivacaine for postoperative pain relief through the epidural route in patients undergoing intra abdominal surgeries ,as a safe and effective agent

Upper extremity surgeries are being mostly done under regional anesthesia using supraclavicular brachial plexus block under ultrasound guidance. Subjective methodsto assess the block success take time and are not very reliable.
Aims- To use perfusion index values for prediction of successful ultrasound guided supraclavicular brachial plexus block.
Materials and methods- This prospective observational study was done on 70 patients who underwent upper limb surgery. Ultrasound guided supraclavicular block was given using 20 ml of 0.5% ropivacaine in all patients. Assessment of sensory and motor block was done at every 5 minute interval. The perfusion index was noted at baseline and at 5, 10, 15, 20, 25 and 30 minutes using separate pulse oximeters on index finger of both blocked and unblocked upper limbs. The perfusion index (PI) ratio was calculated as ratio of PI at 10 minutes and PI at baseline.
Results- There was increase in perfusion index (PI) and PI ratio in the blocked arm compared with the unblocked arm with statistically significant difference.
Conclusion- Perfusion index (PI) and PI ratio at 10 min are good predictors of success of supraclavicular block which can be used non invasively in all patients

Breast cancer is the most common cancer among the woman and is on rise. Surgery is one of main stays of treatment of breast cancer. Pectoral nerve block type 2 is an extension of type 1 that requires additional injection of local anaesthetic between pectoralis minor and serratus anterior muscle.
MATERIALS AND METHODS
This Prospective Randomized Controlled study wad conducted between January and June 2020. 60 Patients undergoing Mastectomy under General Anaesthesia with an ASA of I or II were taken. In Group P, 0.4ml/kg of the drug is deposited above the serratus anterior muscle.
OBSERVATIONS AND RESULTS
The difference in baseline mean systolic and diastolic blood pressures of two groups was statistically not significant. Time of first rescue analgesia is significantly higher in group P (5.89±2.25 hours) than group C (2.08±0.7 hours). Pains scores are significantly higher in group C compared to group P at all times after surgery from 2 to 18 hours postoperatively. The patients who received block used significantly less morphine than the control population. None of the patients in group P experienced block related complications.
DISCUSSION
The perioperative anaesthetic care for those undergoing mastectomy surgery is general anaesthesia with a multimodal approach for analgesics such as opioids, paracetamol and NSAIDs. In our study postoperative Pains scores are significantly higher in group C compared to group P at all times after surgery, similar to other studies.
CONCLUSION
Our study will certainly support the fast-evolving thinking in the field of perioperative medicine, regional anaesthesia and pain management. The results of our study is supportive, in proving, the two-level PECS block is safe, effective, reliable, easy to perform, decreases morphine consumption, improves postoperative pain, provides patient satisfaction, in breast cancer related surgery, thereby, achieving the primary outcome

Levobupivacaine has also been evaluated as a less toxic substitute for bupivacaine and has been found to produce a quantitatively similar neural blockade. So far few data are available concerning the use of levobupivacaine in children. Ropivacaine, a recently introduced bupivacaine analogue drug, is less neurotoxic and cardiotoxic than bupivacaine. Ropivacaine is less lipophilic; hence, it is less likely to penetrate large myelinated motor fibers, resulting in a relatively reduced motor blockade and longer postoperative analgesia and has a greater degree of motor sensory differentiation, which could be useful when motor blockade is not desired. In this randomized, prospective, double blind, single hospital study ninety (90) paediatric patients aged 1 to 10 years undergoing lower abdominal surgery were enrolled. Twenty three patients were excluded as they did not meet the inclusion criteria and seven patients refused to participate.This study was conducted on 60 patients undergoing lower abdominal surgeries. The mean postoperative duration of analgesia was 321.37 ± 24.25 minutes in group L and 309.75 ±23.68 minutes in group R. The difference in the mean duration of analgesia was statistically insignificant (p -value was > 0.05 at all specified intervals).

Introduction: The goal for postoperative pain management is to reduce or eliminate pain and discomfort with a minimum of side effects. Post-operative epidural analgesia provides better static and dynamic pain relief. Ropivacaine is less neuro and cardiotoxic when compared to Bupivacaine with minimal motor blockade thus facilitating early post-operative mobilization.
Aims and Objectives: To Compare Lumbar Epidural Analgesia using 0.25% Bupivacaine (10ml) and 0.2% Ropivacaine (10ml) for post-operative analgesia in abdominal surgeries.
Materials and Methods: A Randomized Comparative Study was conducted on Sixty (60) adult patients of either sex divided in to two equal groups with age group 20-65 years with physical status ASA I, II undergoing abdominal surgeries. At the end of surgery when the patient complained of pain Group B received 10ml of 0.25% bupivacaine and Group R received 10ml of 0.2% ropivacaine as post-operative analgesia.
Results: Both the group B (236.40 ± 29.55 minutes) and group R (244 ± 27.95 minutes) produced almost same duration of post-operative analgesia, but hemodynamic instability was seen with Group B (53.3% reported hypotension and 13.3% reported nausea) along with delay in recovery of motor activity.
Discussion: Group B shows statistical significance with Group R in (HR, SBP, DBP) in first 60 minutes required vasopressor. Group B shows statistical similarity with Group R (P value >0.05) in (HR, SBP, DBP) after 60 minutes, RR, SPO2, onset and duration of analgesia, VAS score, Patient satisfaction score. Group R has less complications than Group B, hence proves statistically significant (P value <0.05).
Conclusion: Post-operative analgesia with 0.2% Ropivacaine provides excellent pain relief with hemodynamic stability and early post-operative ambulation

Introduction: Femur fractures cause moderate to severe pain which requires effective analgesia both preoperatively and postoperatively, poor pain management can have serious physiological and psychological consequences.
Aim: To compare the postoperative analgesic efficacy between 0.25% Bupivacaine and 0.2% Ropivacaine in ultrasound guided fascia iliaca compartment block for femur surgeries under epidural anaesthesia.
Materials and Methodology: This is a randomized clinical study conducted at a tertiary care centre, after receiving approval from institute’s ethical committee. 60 patients posted for femur surgeries under epidural anesthesia were divided into groups of 30 each. Postoperatively ultrasound guided fascia iliaca block using 0.25% bupivacaine 20 ml for group B and 0.2% Ropivacaine 20 ml was given to group R and are compared. The time from fascia iliaca compartment block to first requirement of analgesia for both the groups calculated.
Results: Demographic characteristics and BMI are statistically similar between both the groups. The mean time for duration of analgesia for bupivacaine group was 307.83±34.43 minutes and that of Ropivacaine group was 262.67±31.39 minutes. So, the mean duration of post-operative analgesia of the Bupivacaine group was more than that of Ropivacaine group which was statistically significant. Both the groups maintained hemodynamic stability.
Conclusion: We observed that the postoperative analgesia was definitely of a longer duration with the Bupivacaine group when compared to Ropivacaine group. So, it is concluded that 0.25% Bupivacaine is better in providing prolonged satisfactory postoperative analgesia as compared to 0.2% Ropivacaine when both are used as postoperative analgesia.

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.

Background: Intraoperative pain control by means of local anesthesia is an intrinsic part of clinical practice in oral surgery. The present study compared efficacy of lignocaine, ropivacaine, and bupivacaine in control of pain during extraction of mandibular posterior teeth.
Materials & Methods: 90 patients of mandibular third molar surgical extractions of both genders were divided into 3 groups. Group I was third molar surgeries performed using 2% lignocaine with 1: 80,000 epinephrine, group II underwent surgical extractions of mandibular third molars under 0.75% ropivacaine local anesthesia. Group III were given bupivacaine. Each group has 30 patients. Subject response for pain was recorded using visual Analog Scale (VAS) and verbal Rating scale (VRS).
Results: Group I had 16 males and 14 females, group II had 15 males and 15 females and group III had 13 males and 17 females. VAS showed no pain in 20, 25 and 22, minimal pain in 10, 5 and 8. VRS showed little pain in 18, 28 and 20, moderate pain in 9, 2 and 10, severe pain in 2 and extreme pain in 1 respectively. The difference was significant (P< 0.05).
Conclusion: 0.75% ropivacaine is a better anesthetic when compared to bupivacaine and lignocaine for pain control during third molar extractions.

his study is aimed to compare the effects between 20ml of 0.5% Ropivacaine and 20ml of 0.5% Levobupivacaine in ultrasound guided supraclavicular brachial plexus block for Upper limb surgeries. Methodology: It was a prospective double blinded randomized controlled study in sixty adult patients undergoing upper limb surgeries admitted in Rajah Muthiah Medical college and hospital from November 2020 to November 2022. Result: Significant earlier onset of sensory blockade (p=0.001) and motor blockade (p=0.001), prolonged duration of sensory and motor blockade (p=0.001) was observed in group of patients receiving 0.5% levobupivacaine compared to 0.5% ropivacaine. Intraoperatively throughout the study heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were comparable in both the groups and found no statistically significant difference (p>0.05). The heart rate, systolic and diastolic blood pressure for both the groups were also compared postoperatively and observed no significant statistical difference (p>0.05). No adverse effects were observed in both the groups. Conclusion: 0.5% levobupivacaine used in ultrasound guided supraclavicular brachial plexus block for upper limb surgeries provides rapid onset of sensory and motor blockade and prolonged duration of analgesia compared to 0.5% ropivacaine.

Aim: This study is aimed to compare the effects between 20ml of 0.5% Ropivacaine and 20ml
of 0.5% Levobupivacaine in ultrasound guided supraclavicular brachial plexus block for
Upper limb surgeries.
Methodology: It was a prospective double blinded randomized controlled study in sixty adult
patients undergoing upper limb surgeries admitted in Rajah Muthiah Medical college and
hospital from November 2020 to November 2022.
Result: Significant earlier onset of sensory blockade (p=0.001) and motor blockade (p=0.001),
prolonged duration of sensory and motor blockade (p=0.001) was observed in group of
patients receiving 0.5% levobupivacaine compared to 0.5% ropivacaine. Intraoperatively
throughout the study heart rate (HR), systolic blood pressure (SBP) and diastolic blood
pressure (DBP) were comparable in both the groups and found no statistically significant
difference (p>0.05). The heart rate, systolic and diastolic blood pressure for both the groups
were also compared postoperatively and observed no significant statistical difference (p>0.05).
No adverse effects were observed in both the groups.
Conclusion: 0.5% levobupivacaine used in ultrasound guided supraclavicular brachial plexus
block for upper limb surgeries provides rapid onset of sensory and motor blockade and
prolonged duration of analgesia compared to 0.5% ropivacaine

Background: Enhancing the duration of sensory and motor blockade of regional anaesthesia is often desirable for prolonged surgeries and also provides pain relief in the immediate postoperative period. We performed a prospective, randomised, study to evaluate the effect of Dexmedetomidine and Dexamethasone as adjuvants to Ropivacaine in supraclavicular approach of brachial plexus block.
Study design: The study was a controlled, randomised, double-blinded, prospective study.
Methods: Sixty ASA physical status 1 and 2 patients undergoing elective hand, forearm and elbow surgeries under brachial plexus block were randomly divided to receive either 8 mg Dexamethasone + 30ml 0.5% Ropivacaine or 1 mcg/kg Dexmedetomidine + 30 ml 0.5% Ropivacaine. The block was performed using a nerve stimulator. Onset and duration of sensory and motor blockade and total duration of analgesia were measured. Vitals were recorded at 3, 5,10,15,30 and 45 minutes. Two sample ‘t’ test of difference between two means was used to analyse the differences between various parameters that were used in the cases. Categorical data was assessed by Chi square test and Fishers exact test. P value of < 0.05 was considered significant.
Results: The onset of sensory block and onset of motor block both were found to be sooner with Dexmedetomidine than Dexamethasone. The duration of sensory block and motor blockade and duration of analgesia was longer with Dexmedetomidine than Dexamethasone.
Conclusion: Both Dexmedetomidine and Dexamethasone enhanced the onset and duration of blockade but, the effect was found to be more pronounced with Dexmedetomidine.
 

Background: Effective pain control after surgery is an important part of taking care of someone who has had surgery. A paravertebral block (PVB) is becoming more popular for breast surgery and is thought to be the best method for anaesthesia and pain relief after surgery. Several local and regional anaesthetic techniques were looked at to see if they could reduce post-surgery pain after breast surgery. The thoracic PVB technique looks promising because it reduces post-surgery pain, reduces opioid use, reduces side effects like drowsiness and the risk of breathing problems, and saves money. The goal of this study was to find out how well dexmedetomidine works with ropivacaine as a paravertebral block in breast cancer surgery.
Material and Methods: Randomly, 100 women having breast surgery were split into two groups, Group PR and Group PRD. For thoracic paravertebral block, Group PR got 0.5% ropivacaine (0.3 ml/kg) with 1 ml normal saline, while Group PRD got the same amount of ropivacaine with 1 mcg/ml of dexmedetomidine. The groups were watched to see how well the block worked, how the hemodynamic parameters changed at different times, when the sensory block started, how long it lasted and if there were any complications during or after the surgery.
Results: When added to ropivacaine in TPVB as an adjuvant, dexmedetomidine gives good pain relief during and after surgery and reduces the need for painkillers after surgery. There were no problems with the technique or the way the blood flowed and there were no bad effects from the dexmedetomidine.
Conclusion: TPVB with ropivacaine and dexmedetomidine as an add-on can be a better choice for good pain relief and stable blood flow during breast surgery without complications or side effects.

Background: The potential and duration of analgesia can be increased by adding a suitable alpha 2 adrenergic agonists as adjuvants to ropivacaine during elective lower limb surgical procedures under epidural anaesthesia. Still there is a scope for research on the effects of clonidine and dexmedetomidine as potent adjuvants in epidural local anesthetics. The aim of our study is to compare the effect of clonidine and dexmedetomidine when used as an adjuvant to epidural ropivacaine in lower abdominal and lower limb surgeries.
Materials and Methods: Patients were randomized into fourgroups Group R (n=30) patients received 10ml of 1% isobaric ropivacaine alone, Group RC (n=30) patients received 10ml of 1% isobaric ropivacaine with clonidine 1μg/kg, Group RD (n=30) patients received 10ml of 1% isobaric ropivacaine with Dexmedetomidine 1μg/kg, Group RCD (n=30) patients received 10ml of 1% isobaric ropivacaine with 0.5μg/kg Dexmedetomidine and 0.5μg/kg of clonidine. Onsetofsensory analgesia using colds wab, onset of motor blockade using Bromage scale, time to 2 dermatome regression of sensory level, time to first demand for analgesia, sedationusing Ramsaysedation scale, intra operative hemodynamic parameters and complication swere assessed.
Results: The impressive and practically applicable results were obtained in Group RCD with respect to Results: The impressive and practically applicable results were obtained in Group RCD with respect to time for onset of analgesia (29 ± 3.9 sec), maximum sensory level (T 4.12 ± 1.1), time to peak sensory level (3.49 ± 1.2 min), time for two segment sensory regression (150 ± 12.3min), time taken for sensory regression to s1 (372.5 ± 17.1), duration of analgesia (439.3 ± 64.6 min), regression to Bromage 0 (41±11.3), onset to Bromage 3 (390 ± 32.9 min) and vas score (3.10±0.50).
Conclusion: The study results strongly conclude the use of 0.5μg/kg Dexmedetomidine and 0.5μg/kg of clonidine as aneffective adjuvant to10ml of 1% isobaric ropivacaine forepiduralanesthesia in lower limb and lower abdominal surgeries.

Introduction: The regional anaesthesia for cataract surgery is associated with lesser respiratory and hemodynamic events and quick recovery of function than general anaesthesia.

INTRODUCTION
Ropivacaine is an aminoamide local anaesthetic that is less cardiac and central nervous system (CNS) toxic than other long acting local anaesthetics like bupivacaine. Local anaesthetics alone for supraclavicular brachial plexus block provide good operative conditions but have shorter duration of postoperative analgesia.
MATERIAL AND METHODS
This prospective study was conducted in the Department of Anaesthesia at KD Medical College, Hospital and Research from November 2021to April 2022.After obtaining permission from institutional ethics committee, written informed consent was taken from the participants. Eighty adult patients were randomly allocated to two equal groups (n = 40 in each group) using computer-generated random number list.Patients with the American Society of Anaesthesiologists (ASA) physical status I and II, aged between 25 and 55 years of both sexes undergoing elective orthopaedic surgeries of elbow, forearm, and hand under supraclavicular brachial plexus block were enrolled in the study.  The onset and duration of sensory and motor block, the perioperative vitals and requirement of post operative rescue analgesic were compared by us.
 
RESULTS
In group A 50% of patients achieved grade IV quality of block in comparison to 45% in group B which was not significant (p>0.05). 31 patients required rescue analgesic (intramuscular diclofenac sodium injection) in group A compared to 27 patients in group B.
Conclusion
We conclude that addition of 150 mg magnesium sulphate to ropivacaine 0.50% solution in supraclavicular brachial plexus block prolongs the duration of sensory and motor blockade and reduces the requirement of rescue analgesic in postoperative period with no significant adverse effects.

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%.

Regional anaesthesia techniques have seen numerous modifications over the last few decades with the advent of many newer and safer local anaesthetics. Even with a variety of drugs available, the search for a safer anaesthetic agent has always been given prime importance in all anaesthesia related practices. Till date 0.5% hyperbaric bupivacaine is the most commonly used drug for orthopedic surgeries in spinal anaesthesia. The study was carried out after approval by the institutional ethical committee in the department of Anaesthesiology. Randomization was done using a random number table generated from computer software and divided into 2 groups of 40 each. Group B: 2.5 ml of 0.5% hyperbaric bupivacaine with 25 μg fentanyl, Group R: 2.5 ml of 0.75% isobaric ropivacaine with 25 μg fentanyl. The quality of anaesthesia, as graded by the surgeons, was excellent in 96.66% in both the groups. In only one patient in group R, poor quality of anaesthesia was reported by the surgeon. This patient was well built and there was some difficulty in muscle retraction. Since the patient was comfortable, no supplementation was given and surgery was completed uneventfully.

Introduction: Peripheral nerve blocks are the preferred choice of anaesthesia for surgeries involving the extremities of the human body, with fewer complications. Earlier, the most common drug to be used for the brachial plexus block was bupivacaine, but of late, levobupivacaine and Ropivacaine are used as substitutes to counter the toxicity by Bupivacaine.
Materials and methods: 100 patients aged between 18-60 years with ASA I and ASA II undergoing bony surgeries were randomly divided into Group L and Group R. Group L was given 30 ml of 0.5% Levobupivacaine and Group R was given 30 ml of 0.5% Ropivacaine. Results: The onset of the sensory blockade was significantly lesser in Group L (4.51 ± 0.45 minutes) rather than Group R (5.95 ± 1.33 minutes) while there was no significant difference in the onset of the motor blockade (8.13 ± 2.46 minutes in Group L and 8.42 ± 2.51 minutes in Group R). The duration of the sensory blockage was significantly more in Group L (11.13 ± 2.11 hours) than Group R (9.04 ± 1.42 hours) while there was no difference in the duration of the motor blockade. The duration of analgesia was 11.43 ± 2.17 in Group L and 8.23 ± 1.72 hours in Group R, which was statistically significant.
Conclusion: Since the onset is shorter and duration of anesthesia and analgesic is more effective in Levobupivacaine, it can be used as a preferred drug.

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%.

Introduction: Pain is constant companion for human. There is perhaps nothing as dreaded as pain. Pain is the ultimate teacher. It alerts the body to disease. Depending upon the intensity and duration, it impacts quality of life. Pain after total knee arthroplasty (TKA) is a big concern in orthopaedics. Although opioids and continuous epidural analgesia remains the major option for the postoperative pain management of TKA, they have undesirable side effects like sedation, nausea and hypotension.  Epidural catheterization is skilful and technically demanding procedure with close monitoring. Infiltration of local anesthetic solution minimizes pain at the source superiorly. It has short learning curve, no systemic side effects, no infection, level of motor block is none, early mobilization and cost effective. There is not much study done on combination of Ropivacaine and Clonidine as a LIA.
Material and Methods: A prospective study was carried out among 30 cases undergoing total knee surgery at a tertiary care hospital. During pre-anaesthetic check up detailed assessment of airway, respiratory and cardiovascular system was carried out. Basic laboratory data were reviewed. Informed consent was taken. All patients were kept nil per oral for 8 hours and were pre-medicated with Tab Ranitidine 150mg, Tab Diazepam 5mg orally 12 hours before surgery. Patients were taught the visual analog pain scale (VAS) (0 = no pain, 10 = worst imaginable pain), and VAS was measured preoperatively at rest and on movement of the knee to be operated.
Results: We observed that; mean age was 62.7+9.9 years. Out of 30, 70% were female and 30% were males. Pain control with Ropivacaine and clonidine has been very effective in 1st 24 hours in total knee replacement surgery.
Conclusion: From this study s we concluded that, with the use of local infiltrative anesthesia i.e combination of Ropivacaine & clonidine, requirement of opioid has been decreased. Effects on cardiovascular system like tachycardia, hypertension has also been decreased. It also benefited patient by early mobilization.

Intrathecal hyperbaric bupivacaine for orthopedic surgeries has faster onset but episodes of hypotension, nausea, vomiting is more than intrathecal isobaric ropivacaine. Maximum level of sensory block height is higher with intrathecal bupivacaine compared to ropivacaine in equipotent doses. To detect a significant difference in mean duration of sensory block between groups B (Bupivacaine with fentanyl) and group R (Ropivacaine with fentanyl) with α = 0.05 & power = 80% the minimum number of 40 cases was required in each group. Randomization was done using a random number table generated from computer software and divided into 2 groups of 40 each. The mean of mean blood pressure showed a significant and consistent fall from the baseline after the sub arachnoid block. This fall was seen in both the groups and was statistically highly significant but was clinically within normal physiological limits. Similarly, the difference in the mean of mean blood pressure between the groups were statistically highly significant but were clinically comparable.

Background: Different adjuvants are coadministered with local anesthetics to improve the speed of onset and duration of analgesia, and to reduce the dose, the selection of which is often left to the choice of an anesthesiologist.
Aims: Aim of the study is to evaluate the efficacy &safety of 0.75% Ropivacaine in epidural anaesthesia for lower abdominal surgeries.
Materials and methods: In the present clinical study, 0.75% preservative free ropivacaine is used through epidural route for patients undergoing elective lower abdominal surgeries belonging to ASA grade I and II with in the age group of 20 to 60 years.
We observed the time of onset , highest cephalad spread, two segment regression from highest cephalad spread and total duration of sensory block as well as degree of motor blockade and it's duration, haemodynamic changes, duration of post operative analgesia and side effects , if any.
Results: With 0.75% preservative free ropivacaine, the mean onset time of sensory block for S1, L1, T10, andT6 dermatomal levels are 22.9+/-5.01 mins, 8.48+/- 3.18 mins, 13.4+/-3.88 mins and 29.5+/-3.33 mins respectively. The maximum cephalad spread is T5 dermatomal level and mean time to reach maximum cephalad spread is 29.77+/-4.94 minutes.
The mean duration of sensory blockade and motor blockade are 406.25 +/- 23.22 minutes and 263.58 +/- 21.19 minutes respectively. The motor blockade time is far less than the sensory blockade. Only 6.66% of the total patients achieved the Modified Bromage scale3.
In our present study, the mean total duration of postoperative analgesia is 246.67+/- 42.86 minutes. There are not many changes in the haemodynamics and incidence of side effects and requirement of vasoactive drugs were minimal.
Conclusions: 0.75% ropivacaine has a longer duration of sensory blockade and the duration of motor blockade is for less than the sensory blockade, their by providing post operative analgesia for nearly more than four hours. It appears to be an ideal and safe local anaesthetic for these surgeries.

Introduction: Supraclavicular block is preferred for its rapid onset, reliability and a safetechnique for
surgeries involving the upper limb. Several local anaethetics have
beenusedandproveneffectivewithvariousefficacies.
Aims: To study and compare the efficacy of 0.5% Ropivacaine with 0.5% Levobupivacaine in
supraclavicular brachial plexus block in patients undergoing elective upper limb surgeries.
Materials and methods:
Inourprospectiveclinicalstudy,wecomparedLevobupivacaineandRopivacaineforprovidingsupraclavicularbl
ockin60patients. We demonstrated that a volume of 30 ml of Levobupivacaine and Ropivacinewas
sufficient to provide a satisfactory and a successfulsupraclavicular block withthehelpofultrasoundguidedtechniquekeepinginmindthetoxicdoses.
Results:There were no observable changes in both the groups on comparing the vitalswhichincluded heart
rate, systolic blood pressure, diastolic blood pressure andoxygensaturation. Sensory block onset and
duration in Ropivacaine group was statisticallysignificant.Motor block onset of both were comparable and
did notshowanystatisticalsignificance.. The mean duration of motor blockade were
foundtobesignificantstatistically. The duration of analgesia werefoundtobe statistically significant.
Levobupivacaine providingalonger durationofanalgesia. There were no significant changes in baseline
parameters, heart rate, bloodpressuresandsaturationinboththegroups.
Conclusion: Levobupivacaine would be a better option to choose insupraclavicular brachial plexus
blockwhere prolonged postoperativeanalgesia isrequired.

Background and Objectives: Patients undergoing forearm surgeries have benefited considerably with the widespread use of brachial plexus block instead of general anaesthesia. This study was conducted to investigate the efficacy of 0.75% Ropivacaine in supraclavicular brachial plexus block and to compare the results with 0.5% bupivacaine, which is already established as local anaesthetic for regional anaesthesia.
Methods: Sixty patients of ASA-I and II consenting adult patients undergoing elective upper limb surgeries were randomly divided into Group A and Group B. Group A received 30 ml of 0.5% Bupivacaine and Group B received 0.75% Ropivacaine in supraclavicular block after authenticating the position of brachial plexus with nerve stimulator. Patients were monitored for peak onset and duration of sensory and motor blockade and post-operative analgesia using visual analogue scale. Patients were also observed for any complications during the surgery and in the postoperative period. Sensory and motor block peak and duration of analgesia were evaluated statistically using unpaired t-test and p-value <0.05 was considered significant.
Results: There were no significant differences between the study groups with respect to pattern of changes in Heart rate, Systolic blood pressure, Diastolic blood pressure, Mean arterial pressure perioperatively.
Peak sensory blockade was attained faster in Group B (Ropivacaine) i.e. 13.10 ±2.5 minutes compared to Group A (Bupivacaine) i.e. 23.33 ±3.1 minutes which is statistically significant. Duration of sensory blockade was also longer in Group B (Ropivacaine) i.e. 720.66 ±38.09 minutes compared to Group A (Bupivacaine) i.e. 672.66 ±105.95 minutes and is statistically significant. Onset of Motor blockade was faster in Group B (Ropivacaine) i.e. 18.03 ±2.4 minutes compared to Group A (Bupivacaine) i.e. 24.76±3.1 minutes which is statistically significant. Duration of Motor blockade in Group A (Bupivacaine) was 637.100 ±88.72 minutes compared to Group B (Ropivacaine) i.e. 646.17 ±38.07 minutes and is statistically
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not significant. Also, the time for demand of rescue analgesics was prolonged in Group B (Ropivacaine) i.e. 752.66 ±40.33 minutes compared to Group A (Bupivacaine) i.e. 694.56 ±106.14 minutes and this difference is statistically significant.
Conclusion: Ropivacaine 0.75% has an added advantage over Bupivacaine 0.5% for Supraclavicular Brachial Plexus block in terms of early onset of sensory and motor blockade, prolonged duration of sensory blockade, and prolonged duration of analgesia leading to lesser requirement of rescue analgesic. The side effects and complications rate are almost negligible in both groups. Thus Ropivacaine even at higher concentrations of 0.75% and 30 ml volume has proven to be an absolutely safe local anaesthetic. So on the basis of our study we conclude that Ropivacaine 0.75% is an excellent choice for local anaesthetic, which provides better and safer regional anaesthesia.

Background and Aims: Postoperative pain remains the most important cause of morbidity. Thus, a good postoperative analgesia is required but at the same time any untoward complication is to be avoided as patient is in a ward setting which is not a continuous monitoring setting always. Epidural local anaesthetics with good safety profile remain a safe modality in such settings. Our aim is to compare the efficacy, haemodynamics and side effects of Epidural 0.2%Ropivacaine versus 0.2%Bupivacaine for post-operative analgesia in abdominal surgeries.  
Materials and Methods: A comparative study of 80 patients undergoing elective abdominal surgeries were allocated into two groups using Computer generated randomization. Postoperatively, one group received epidural Bupivacaine 0.2%, upto10cc and other received ropivacaine 0.2% 10cc. Pre-emptive epidural analgesia in the form of Bupivacaine/Ropivacaine administered at the time of closure and duration of analgesia was taken from time of extubation till analgesic is asked for the first-time post operatively.  Rescue analgesia administered in the form of epidural Bupivacaine or Ropivacaine in the respective groups. Assessment done by a blinded anesthesiologist. Statistical analysis done using SPSS software version 20 and Epi Info 7.2.1.
Result: Though both the drugs maintained a comparable hemodynamic profile, there was better patient comfort at rest in ropivacaine group with lower VAS scores and lesser demand for rescue analgesia. Significantly higher number of adverse effects were found in bupivacaine group (n=36) as compared to ropivacaine group (n=6), specifically, fall in blood pressure and motor deficit.
Conclusion- Ropivacaine provided better post-operative analgesia as patients required lesser amount of rescue analgesia as well as mean time was comparatively longer for the first top up in comparison to Bupivacaine. Ropivacaine was also found to have a better safety profile alongwith distinct motor sensory differentiation

Background: Intravenous regional anaesthaesia(IVRA), also known as Biers Block is a
technique of producing surgical anaesthesia by intravenous injection of a local
anesthetic into a limb whose circulation has been interrupted by a
tourniquet.Ropivacaine is a safer alternative among available local anaesthetics with
analgesic duration 4-8 hrs. Dexamethasone is a long-acting synthetic corticosteroid and
is beneficial anti-inflammatory agent for the management of acute surgical pain.This
study was done with the aim to comparethe effectiveness as well the onset and duration
of sensory block, motor block and analgesia between ropivacaine alone and ropivacainedexamethasone
in regional anaesthesia.
Methods: 50 adult patients of ASA grade I & II in the age group of 20-50 years were
randomized into two groups of 25 patients, scheduled for ambulatory hand surgery
andwere administered intravenous( IV)Ropivacaine (0.2%) 40 ml and IV
Ropivacaine(0.2%)40ml plus 8mg Dexamethasone after inflating the proximal cuff of
tourniquet and assessment was done with pin prick and visual analogue scale
(VAS)score.
Results:This study showed, the duration as well as the recovery of sensory block was
prolonged on adding dexamethasone. In group receiving dexamethasone as an adjuvant
to ropivacaine the duration of analgesia was prolongedas well as the total analgesic
consumption was reduced. Conclusion: IVRA is a safer technique and addition of
dexamethasone to ropivacaine increases the analgesic efficacy as well the duration of
sensory block which decreases pain scores and attributes to early recovery as well as
short hospital stay.

Introduction: One of the primary aims of anesthesia is to relieve the patient's pain and
agony, thereby the surgical procedures can be conducted without any discomfort. Relief of
intraoperative and postoperative pain has gained importance in recent years, considering the
central, peripheral and immunological stress response to tissue injury. Any expertise acquired
in this field should be extended into the postoperative period, which is the period of severe,
intolerable pain requiring attention. So there is need of extended analgesia without any side
effects in the process of achieving this goal. “Regional anaesthesia” is the term first used by
Harvey Cushing in 1901 to describe pain relief by nerve block 1. Regional nerve blocks are
based on the concept that pain stimulus conveyed by nerve fibers, which are amenable to
interruption anywhere along their pathway 2. Brachial plexus block is a valuable and safe
alternative to general anesthesia in upper limb surgeries. Interrupting the acute pain which
can help in limiting the development of chronic pain syndromes 3, 4. The effects of opioids on
regional blockade is controversial. So the present study is being undertaken to evaluate
Fentanyl as an adjuvant to Ropivacaine in supraclavicular brachial plexus block.
Methodology: Hospital based Prospective randomized single blinded study. Conducted on
eighty patients of ASA I and II posted for upper limb surgeries under supraclavicular block.
Patients were divided randomly by means of random number table generated by computer
into two groups as A and B. Each group consisting of 40 patients. Prior to the study
Institutional Ethical committee approval and consent from the patients were taken. The study
was conducted in the Department of Anesthesiology, at Katuri medical college &Hospital,
Guntur from January 2016 to October 2017.

Background:
Postoperative pain after total knee replacement surgery is an unpleasant memory for the patients.
Different techniques have been tried to elevate the post-operative pain. A femoral nerve block
with local anaesthetics is considered to bethe gold standard for postoperative pain.But the painfree
period after the femoral nerve block lasts for a few hours only.Several adjuvants have been
triedwith local anaestheticsto prolong analgesics’ duration and avoid the adverse effects of
NSAIDsandopioid use.
Objective:
In this study, we have used dexamethasone as an adjuvant withropivacaine to prolong the
duration of analgesia effect, in a single dose of perineural femoral nerve block after total knee
arthroplasty.
Methods:
It was a prospective, randomized, controlled study, sixty patients were randomly assigned to one
of two groups:Group R or Group RD. In Group R, 40 mL of 0.375% ropivacaine was used, and
in Group RD 8 mg of dexamethasone was used as an adjuvant to 40 mL of 0.375%
ropivacaine.The primary endpoint was to check the duration of analgesia after the femoral nerve
block and the secondary endpoint was to check the amount of rescue analgesic consumed in the
first 24 hours, postoperatively.A visualanalogue scale (VAS) score was used to access the pain
with 1 being the least pain and 10 being the highest. The adverse reactions to the drugs were also
noted in both groups.

Introduction: TAH is associated with significant post-operative pain. Epidural analgesia
with a variety of local anaesthetics and adjuvants is widely used for TAH as it provides both
intra and post-operative analgesia. The aim is to compare the effect of post-operative epidural
analgesia with 0.2% ropivacaine and dexmedetomidine versus 0.125% levobupivacaine and
dexmedetomidine in patients undergoing TAH.
Method: Afterobtaining ethical committee permission and patient consent, 50 women aged
35-65 years of ASA 1&2 were included in the study. We have excluded patients with
hypersensitivity to local anaesthetics, infection at the site of injection. Patients were divided
into 2 groups of 25 each. Group RD-received 10ml of 0.2% ropivacaine and
dexmedetomidine 1 mcg/kg. Group LD-received 10ml of 0.125% levobupivacaine and
dexmedetomidine 1mcg/kg. Using chi-square test and student t-test statistical results were
obtained.
Results: The mean onset of analgesia in Group RD was 11.86min and in Group LD was
8.468min which is statistically significant (P<0.05). Mean duration of analgesia in Group RD
was 210min and in Group LD was 271min which is statistically significant (P<0.05).
Conclusion: We conclude that 0.125% levobupivacaine with dexmedetomidine as adjuvant
was found to have faster onset and prolonged duration of analgesia than 0.2% ropivacaine
with dexmedetomidine.

The brachial plexus is enveloped by a fascial sheath, formed by prevertebral and scalene
fascia, extending from the intervertebral foramina to the upper arm. The foramina of a sheath,
at any anatomical point, will allow for the spread of local anaesthetics and subsequent
blockade. Each approach to the brachial plexus impacts specific anatomical areas of the upper
extremity. Patients were kept Nil per orally for 6 hours before the time of surgery and on the
previous night premedicated with Diazepam 5 mg and Ranitidine 150mg. 60 patients ASA I
and ASA II were randomly allocated with sealed envelope method into two different groups
of 30 each. Both observer and participant were blinded. GROUP A- received (n=30) 25 ml of
0.5% bupivacaine, GROUP B-received (n=30) 25 ml of 0.5% ropivacaine. There was no
statistically significant difference in heart rate between both groups (p>0.05). There is no
significant difference of heart rate clinically.

We have done this trialin order to correlate analgesic dexmedetomidine (DXM) &dexamethasone (DX) efficacyin form of an additive for supraclavicular brachial plexus(SCBP)‘s ropivacaine blockage for upper extremity surgery. This is trial in which, 18–65 yrs 70 ASA status type one and two individuals suffering from disease, posted for upper extremity surgery was splitrandomly within couple of categories. Class DXMgot 2 mlof normal saline containing dexmedetomidine (1mcg/kg) with 0.5%ropivacaine(30 ml) and Class DXgot 2 ml(8 mg) of dexamethasone with 0.5%ropivacaine(30 ml). SCBP block was performed under ultrasonography(USG). The primary outcome was time of 1st analgesic request and no of analgesic request in 1st 24hrs. Secondary endresult of the trial were Motor block& sensory were secondary trial end result onset & time & incidence associated with drug’sside effects. Time for request of 1st rescue analgesia was 720.50±67.87min in Class DXM and 591.83±52.25min in Class DX. Total rescue analgesia required within post -operative for 1 dayinto DXM Class is less in comparison to DX Class. The mean of onset time of motor block& sensory into Class DXM is lesser in comparison to Class DX, which is statistically important. In Class DXM mean of duration of sensory block was 656.50± 50.58min, which was significantly longer than Class DX where duration was 534.10± 62.43min. Mean of motor block duration was 611.83± 45.3min in Class DXM and 470.83± 59.40min in Class DX (p<0.001). Dexmedetomidine provided prolonged relief from suffering after utilizing it in form of an additive to SCBP portion’s ropivacaine when compared to dexamethasone