Osteosynthesis with open reduction technique in comminuted fracture has several disadvantages like increase rate of non-union, soft tissue problem, infection and implant failure. These problems may be overcome by percutaneous bridge plating technique which preserve the vascularity and soft tissue attachment of fracture fragments. MATERIALS AND METHODS: Twenty-five patients were involve in this study. All of twentyfive patients with closed comminuted diaphyseal fractures of femur (n-10) and tibia (n-15) were operated on using the principle indirect reduction and biological fixation with bridge plate under image intensifier. Partial and full weight bearing were allowed according to clinical and radiological union. RESULTS: Most regained excellent range of motion of knee and ankle. Mean time of radiological union was 20.12 weeks. Two patients had superficial skin problem which healed with local wound care. One patient had non union which was healed by bone grafting. In this study excellent result was seen in 18 cases, good in five and fair in two patients. CONCLUSION: Our study indicates that minimally invasive bridge plating is an effective alternative for treatment of comminuted diaphyseal fracture of long bones. These complex fractures give complete recovery of normal limb function at an early stage with less complication.

BACKGROUNDLevobupivacaine is the S (-) isomer of bupivacaine, developed as an alternative to bupivacaine for regional anaesthesia after the evidence of its less cardiotoxicity and neurotoxicity. The present study was undertaken to compare the quality of sensory and motor block, haemodynamic changes and side effects if any, following intrathecal levobupivacaine and hyperbaric bupivacaine, in parturients undergoing elective caesarean section. MATERIALS AND METHODSNinety parturients of ASA status I or II for the elective caesarean section were enrolled in this prospective randomised, doubleblinded study. The parturients were randomly assigned to two groups with patients in Group L (n = 45) and Group B (n = 45). Subarachnoid block was performed with 2.5 mL of 0.5% isobaric levobupivacaine in Group L and 2.5 mL of 0.5% hyperbaric bupivacaine in Group B. Characteristics of sensory and motor block were assessed with pinprick using Hollmen scale and modified Bromage scale, respectively. Side effects such as hypotension, bradycardia, nausea, and vomiting were recorded. Observed data were analysed with the help of Statistical Package for Social Sciences (IBM SPSS software version 20). RESULTSThe two study groups were comparable in terms of age, height, body weight and duration of surgery. Patients who received intrathecal levobupivacaine (Group L) experienced effective spinal anaesthesia with significantly late onset of sensory and motor block (5.72 min. vs. 5.13 min.; p=0.001 and 7.0 min. vs. 5.47 min.; p=0.001), but longer duration of analgesia (124.49 min. vs. 120.58 min.; p=0.001) in comparison to the patients who received intrathecal bupivacaine (Group B). Few patients experienced shivering, few reported nausea and vomiting in both groups intraoperatively. CONCLUSIONIntrathecal levobupivacaine seems to be an effective alternative to intrathecal bupivacaine in infra-umbilical surgeries like caesarean section with reduced toxic potential and excellent quality of analgesia.

BACKGROUNDLaryngoscopy and endotracheal intubation produces distinct but transient increase in cardiac workload. In this study, a comparison is made between dexmedetomidine, esmolol and control in their effect in attenuation of pressure response during laryngoscopy and endotracheal intubation.

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BACKGROUND Epidural anaesthesia is widely accepted for lower limb surgery in terms of avoidance of laryngoscopic surge, better perioperative pain management, greater patient satisfaction and attenuation of neuroendocrine response to surgery. Among many drugs, α₂adrenergic agonist has been used widely as an adjuvant to local anaesthetics due to its better analgesic and sedative property without significant respiratory depression. The aim of this study was to compare the analgesic and sedative effects of dexmedetomidine and clonidine in epidural anaesthesia. MATERIALS AND METHODS 86 patients of either sex aged 40-65 years and body weight of 40-70 Kgs of ASA class I-II, posted for elective lower limb orthopaedic surgeries were randomly allocated in two equal groups either to have 0.75% ropivacaine and dexmedetomidine (group RD) or 0.75% ropivacaine and clonidine (group RC) and were observed regarding block characteristics in term of onset and duration for maximum sensory level achieved, time to complete motor block ,intraoperative and postoperative sedation level, time to two segment regression of sensory block, time to first analgesic requirement, hemodynamic stability and adverse effects. Postoperative epidural top-up dose of 8 ml 0.2% ropivacaine was used as rescue analgesia. Observed data were tabulated in the Excel sheet and analysed with SPSS for windows (Version 12.0). Categorical data are presented as percentage of number of patients [n (%)]; continuous data are expressed as mean ± SD. Statistical analysis was done using independent samples t test (continuous data) and Chi-square test (Categorical data). A 'p' value <0.05 has been considered as statistically significant. RESULTS Onset of sensory and complete motor block and time to reach maximum sensory block was earlier in dexmedetomidine group (p<0.05). Mean time to two segment regression of sensory block and first rescue analgesia was longer in dexmedetomidine group (p<0.05). Intraoperative sedation was more in dexmedetomidine group (p<0.05). Other variables are comparable in both groups. CONCLUSION Dexmedetomidine has earlier onset of sensory and motor block, provides longer duration of analgesia and better intraoperative sedation than clonidine when administered as an adjuvant in epidural anaesthesia.