Background: To study the effect of magnesium sulphate as an adjuvant to Bupivacaine and Ropivacaine in ultrasound guided interscalene block in patients scheduled for orthopedic surgeries around the shoulder. Methods: Sixty patients (20-60 years) posted for elective orthopedic surgeries around the shoulder under interscalene brachial plexus block were divided into two Groups B and R in a randomized fashion. In group B (n = 30), 20 ml 0.5% bupivacaine plus 150 mg (3 ml of 50:1 solution) magnesium sulfate and in group R (n = 30), 20 ml 0.5% Ropivacaine plus 150 mg (3 ml of 50:1 solution) magnesium sulfate was administered in ultrasound guided interscalene block. After performance of the block it was evaluated for its onset time and duration of sensory and motor block every 3 min up to 30 min and subsequently hourly intervals up to 24hr. The time of first analgesic demand (VAS>4), total analgesic need, hemodynamic stability and side effects were recorded during the study. Results: The duration of sensory and motor block and the time to first analgesic demand was significantly longer (P<0.05) in Group B. In addition the total need for rescue analgesics in the post-operative period was also significantly lower (P<0.05) in this group compared to Group R. Intraoperative hemodynamics was comparable and no appreciable side effect was noted in the study. Conclusion: This study demonstrates that the addition of magnesium sulfate to Bupivacaine when compared to Ropivacaine in interscalene brachial plexus block provides enhanced sensory and motor block duration, prolonged duration of analgesia and decreased total postoperative analgesic needs with no side effects, hence could be a more rational combination.

Background: Tracheal extubation is always linked with hypertension, tachycardia, and high-plasma catecholamine levels. These hemodynamic fluctuations are seen more often in hypertensive patients than in normotensives. The present study evaluates the effects of three different doses of dexmedetomidine in hypertensive patients relative to each other in attenuating extubation response. Patients and Methods: In this randomized, controlled, triple-blinded study, 105 controlled hypertensive patients of either sex on antihypertensive drugs in the age group of 30–70 years, scheduled for laparoscopic cholecystectomy were included. They were randomized into Groups A, B, and C receiving 0.5 μg/kg, 0.75 μg/kg, and 1 μg/kg of dexmedetomidine 10 ml infusion 10 min before extubation. Hemodynamic parameters in form of pulse rate, systolic and diastolic blood pressure, mean arterial pressure (MAP), oxygen saturation, and bispectral index (BIS) were noted. Extubation time, quality, and sedation were evaluated. Any side effects in form of postoperative nausea, vomiting, and bradycardia were noted. Results: There was significant attenuation of rise in heart rate, systolic, diastolic, and MAPs after 4 min of starting infusion between the three groups. At extubation, the values of hemodynamic parameters and BIS were significant between the three groups (P < 0.001). While the quality of extubation improved and the sedation scores increased with the increase in the dose of dexmedetomidine, the incidence of bradycardia was more with dose of 1 μg/kg as compared to 0.75 μg/kg and 0.5 μg/kg. Conclusion: It was found that 0.75 μg/kg was the optimal dose for extubation as it facilitated smooth extubation and maintained hemodynamic stability in patients without causing undue sedation.

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Finding the best analgesic technique for breast surgeries has always been a matter of great concern. Stable intraoperative hemodynamics and comfortable postoperative patient is what every anesthesiologist aspire of. The benefits of using regional blocks for postoperative analgesia is well known. Hence we intended to study the analgesic efficacy of two of the most latest blocks, used for breast surgeries, the PECS block and the ESP block. Materials and Methods:The prospective open label study was conducted in 59 ASA 1, 2 patients, planned for Modified Radical Mastectomy(MRM) under general anesthesia. After approval from institution scientific and research committee, and obtaining written informed consent, the patients were randomly divided into two groups(P and E). Group P(N=30), received ultrasound guided modified PEC block with 30ml of 0.25% levobupivacaine. Group E(N=29) received ultrasound guided ESP block with 30 ml of 0.25% levobupivacaine. General anesthesia was then administered in both the groups. The intraoperative hemodynamics, duration of analgesia, VAS score, number of rescue analgesia, patients satisfaction, safety and side effects were noted and compared between the two groups. Results: The mean VAS score at 24 hours was 4.11 ± 0.629 in group P and the mean VAS score at 24 hours post operatively was 3.69 ± 0.679 in group E, and the difference was statistically significant (P=0.024). Conclusion:Both PECS and ESP block can be used efficaciously for providing analgesia for MRM surgeries, with ESP block providing longer duration of pain free postoperative period, without any noted side effects and technical difficulties.