Background and Aims: Subarachnoid block is the most commonly used anaesthesia technique for lower limb surgeries. Opioids are the most commonly used adjuvants with local anesthetics (LA). Adjuvants are given premixed with LA loaded in a single syringe. This study was conducted to evaluate differences in level of sensory and motor block and incidence of hypotension whilst administering hyperbaric bupivacaine and fentanyl either in a single syringe or different syringes. The effect of administering opioid prior to LA and vice versa on these parameters was also assessed. Methods: One hundred and twenty patients were randomly allocated into three groups of 40 each: Group A received premixed 0.5% heavy bupivacaine 2.5 ml (12.5 mg) and 0.5 ml (25 microgram) of fentanyl in a single 3.0 ml syringe, Group B received 0.5 ml (25 microgram) of fentanyl in a 3.0 ml syringe followed by 0.5% heavy bupivacaine 2.5 ml (12.5 mg) in a 3.0 ml syringe, Group C received 0.5% heavy bupivacaine 2.5 ml (12.5 mg) in a 3.0 ml syringe followed by 0.5 ml (25 microgram) fentanyl in a 3.0 ml syringe. All statistical calculations were done using SPSS 21 version statistical program for Microsoft Windows. Results: The mean time for onset of sensory and motor block was least in group C followed by group B. The duration of sensory and motor block was prolonged in groups B and C. Patients in group A experienced more hypotension as compared to groups B and C. Conclusion: Administering hyperbaric bupivacaine first followed by fentanyl leads to an early onset and prolonged duration of sensory and motor block.

Background and Aims: Transversus abdominis plane (TAP) block is commonly used to treat post-operative pain after lower abdominal surgeries. The aim of this randomised controlled study was to assess the efficacy of addition of dexmedetomidine or dexamethasone to ropivacaine in TAP block and compare the two for post-operative pain relief in caesarean section. Methods: A hundred parturients (18–45 years) undergoing caesarean section under spinal anaesthesia received ultrasound-guided (USG) bilateral TAP block with 50ml of 3mg/kg ropivacaine along with 0.1mg/kg dexamethasone (Group A) or 1μg/kg dexmedetomidine (Group B) in this prospective, randomised, double-blind study. Time to initial self-reporting of post-operative pain, time to first rescue analgesic demand, visual analogue scale (VAS) for pain haemodynamic parameters and adverse effects if any were noted, anda P value < 0.005 was considered as statistically significant. Results: Time to initial self-reporting of post-operative pain (411.35 vs. 338.20 min, P < 0.005) and time to first rescue analgesic (474.30 vs. 407.30 min, P < 0.005) were significantly longer in group B as compared to group A. VAS score at the time of initial self-reporting of pain was significantly lower in group B. No significant haemodynamic changes or side-effects were noted. Conclusion: Addition of dexmedetomidine to ropivacaine as compared with dexamethasone in bilateral TAP block following caesarean section prolongs the time to initial post-operative pain and time to first rescue analgesic consumption.

BACKGROUND Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic gall stones due to decreased postoperative pain, earlier oral intake, shorter hospital stay, early resumption of normal activity and improved cosmesis. Laparoscopic cholecystectomy may be rendered difficult because of various problems encountered during surgery such as difficult in access to the peritoneal cavity, creation of pneumoperitoneum, gall bladder dissection or extraction of the excised gall bladder. This provoked an interest in studying the factors that could predict the successful completion of the early laparoscopic cholecystectomy. The aim of this study is to define specific parameters for predicting difficulty of laparoscopic cholecystectomy pre-operatively. MATERIALS AND METHODSWe conducted a prospective, observational study on 50 cases of symptomatic cholelithiasis who underwent laparoscopic cholecystectomy at our institute during a period of 1 year. Patients with choledocholithiasis or prior history of partial cholecystectomies and suspicion of malignancy were excluded from the study. Various clinical and radiological parameters were noted and the patients were scored to predict difficulty in surgery. Assessment of the difficulties encountered in terms of duration of surgery, bleeding during surgery, difficult access to peritoneal cavity, gall bladder bed dissection, conversion to open cholecystectomy and post-operative morbidity and hospital stay were noted and results were compared to the pre-operative scores. RESULTSFactors such as age, abdominal scar and BMI had no role in the conversion of laparoscopic cholecystectomy. Prior history of an acute attack, palpable and thickened gall bladder, presence of pericholecystic fluid, impacted stone in gall bladder neck had effect on determining the difficulty of laparoscopic cholecystectomy. CONCLUSIONSelection of patients for laparoscopic cholecystectomy is must to avoid all these preventable complications. KEYWORDSInjury during Cholecystectomy, Conversion, Open Cholecystectomy. HOW TO CITE THIS ARTICLE: Bhagtana A, Singh N, Mahajan A, et al. Prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonography parameters.

BACKGROUNDThe term diabetes mellitus is a metabolic disorder characterised by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, action or both. Non-traumatic amputations mostly arise from diabetes mellitus and the chances are 15 -46 times higher in diabetics. Further, foot complications are the most frequent reason for hospitalisation in patients with diabetes mellitus, accounting for up to 25% of all admissions. Objective-To study the role of recombinant platelet derived growth factor in Wagner's grade 2 diabetic foot ulcer. MATERIALS AND METHODSIn a prospective study on 50 patients, 25 patients were undertaken in the study group (Group A) and 25 patients in the control group (Group B). Study group received PDGF gel, while the control group received Betadine dressing. Patients were followed up after every two weeks up to eight weeks. Qualitative analysis was done according to the wound size, discharge type, discharge amount, cellulitis and granulation tissue. RESULTSThe platelet derived growth factor plays a significant role in the treatment and outcome of diabetic foot ulcers. The end result was significant in all the measured parameters. 24 out of 25 patients in study group attained the end result as compared to 4 out of 25 patients in control group. In study group, there was significant reduction in the size of wound at 7 th week. In study group end point results were achieved in 96% cases, which included the complete closure of wound either by healing, suturing or skin grafting. CONCLUSIONRecombinant platelet derived growth factor plays a significant role in treating diabetic foot ulcers.

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