Background: Axillary Brachial Plexus Block has gained popularity in forearm surgeries. Addition of adjuvants to local anaesthetics can prolong postoperative analgesia. But there are very few studies comparing Fentanyl and Dexmedetomidine as adjuvants to Bupivacaine in axillary block. Hence we carried out comparative evaluation of two drugs as adjuvants among patients undergoing forearm orthopaedic surgeries. This prospective Methods: randomized double blind study included eighty patients of either gender aged 18 to 60 years, ASA-I/II, scheduled for forearm surgeries divided into two groups of 40 patients each using opaque sealed enveloped technique . BF group: 24 ml volume of 0.25%Bupivacaine+ Fentanyl 1mcg/kg. BD group: 24 ml volume of 0.25%Bupivacaine+ Dexmedetomidine 1mcg/kg. Patients were observed for onset, peak effect, duration of post operative analgesia and perioperative complication, if any. Mean durat Results: ion of post operative analgesia was signicantly prolonged in BD group compared to BF group (1000.77±37.71 vs 795.62±45.69 minutes), (p<0.0001). While onset and effect of complete block was achieved earlier in BF group. Grade 1 post operative sedation score was seen in 10% cases of BD group. There was no signicant haemodynamic disturbances perioperatively. Conclusion: Dexmedetomidine as adjuvant to Bupivacaine in Axillary brachial plexus block for orthopaedic forearm surgeries produced prolonged duration of post-operative analgesia compared to Fentanyl adjuvant without signicant adverse effect.

In lower leg surgeries involving fractures of distal tibia, ankle surgeries, debridement and PVD surgeries choice of anesthesia is usually regional anesthesia. When these patients are associated with co-morbid cardio-respiratory problems then it will become challenge for anesthesiologist to maintain homeostasis with good surgical anesthesia. Ayukut urfalioglu suggested another alternative technique in the form of Adductor canal block plus Lateral approach popliteal sciatic block as good alternative for these surgeries with better Intra-operative Haemodynamic Stability, additional post-operative pain relief and less requirement of systemic analgesia post-operatively.In this prospective randomised controlled trial, we aim to explore the efficacy of Adductor canal block plus Popliteal Sciatic Block for Lower leg surgeries. Sixty patients (ASA I, II, III) undergoing lower limb surgeries were randomly allocated in 2 groups (30 patients in each group). In Group P patients received PNS guided Adductor canal block combined with popliteal sciatic block and in group S patients received unilateral spinal anesthesia.: The primary objectives were to evaluate duration of sensory and motor block and post-operative pain relief. Secondary objectives included intra operative requirements of additional anesthesia and intraoperative haemodynamic stability.There was significant intraoperative haemodynamic stability and post-operative pain relief attributable to Group P. Time for first requirement of rescue analgesia post-operatively was significantly higher in Group P compared to Group S (Group P Mean SD15.9±5.26 vs 6.05±1.23 in Group S with p= &#60; 0.0001).Combined adductor canal block and popliteal sciatic block can be an alternative technique with advantage of prolonged post-operative analgesia and haemodynamic stability.

Introduction: Femoral Nerve Block (FNB) renders marked postoperative analgesia in patients undergoing knee surgery and use of adjuvant to Local Anaesthetic (LA) agent is more advantageous in lengthening duration of sensory effect of block. Aim: To evaluate the effect of addition of dexmedetomidine to 0.2% Ropivacaine in FNB. Materials and Methods: The randomised clinical trial was conducted at Medical College and SSG Hospital, Vadodara, Gujarat, India which included 60 patients of either sex, American Society of Anaesthesiologists (ASA) Grade-I,II,III posted for open knee surgery. Patients were randomly allocated to two groups-Group RD patients received 0.2% ropivacaine 20 milliliter (mL) with dexmedetomidine 2 mL (50 μg) and Group R received 0.2% ropivacaine 20 mL with normal saline 2 mL for FNB. Duration of postoperative analgesia, total requirement of systemic rescue analgesic in 24 hours, vital parameters and complications were observed. Statistical analysis was done with Medcalc 14.8.1 statistical software. A p<0.05 considered as significant. Result: Duration of analgesia was significantly longer in Group RD (484±26.98 min) than in Group R (338±29.40 min), p<0.0001. Mean postoperative cumulative requirement of analgesic (Tramadol) was lesser in Group RD (207±25 milligram (mg)) than in Group R (290±30 mg), p<0.0001. Conclusion: Dexmedetomidine to ropivacaine 0.2% for FNB significantly augments duration of analgesia and reduces requirement of systemic analgesic declining its unfavourable effect.