BACKGROUNDEpidural analgesia is considered by many as 'gold standard' of analgesic technique for postoperative analgesia after lower limb as well as abdominal surgeries. Epidural analgesia has the ability to maintain continuous analgesia after placement of an epidural catheter with the analgesic drug thus making it suitable for continuous postoperative pain relief and early ambulation. Epidural opiates in combination with local anaesthetics are commonly used for postoperative analgesia with several lines of evidence indicate that opiates administered through the epidural route are safe with proven benefits such as good pain relief, less pain during movement, better mental status, fewer complication. Even though bupivacaine, the ideal local anaesthetic and has similar pharmacological profile with ropivacaine, but which cardiac safety margin is lower than ropivacaine due to its Senantiomer.

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Background: One of the most frequent side effects is acute and often profound hypotension that increases the risk of perioperative neurological & cardiovascular events especially in elder. The different studies on animal have suggested that serotonin may be an important factor inducing BJR. This is having a significant impact on decreasing the blood volume and helps to change the mechanism that triggering the activation of 5-HT3 receptors that is located in intracardiac vagal nerve endings by serotonin. Aim: The aim of the present study is to evaluate the efficacy of intravenous Ondansetron in preventing the incidence of hypotension in non-obstetrical surgical procedures in AGMC & GBP Hospital. Methods: Patients of both sexes physical status grade l and ll, age between 20 to 60 years, scheduled for any elective lower abdominal and lower limb surgeries (non-obstetric population) under spinal anaesthesia. The data were collected for both the groups as per the study tools and is depicted in comparative charts. Mean ± SD (Standard Deviation) was calculated for quantitative variables like age, weight, BMI, and MAP. Results: The proportion of males/ females in both the groups was almost similar with no statistically significant difference. However a statistically significant difference was marked in the body weight of the two groups. Comparison of the development of nausea after spinal anesthesia between patients in the Ondansetron and Normal Saline groups show that the proportion of patients that developed hypotension was higher in the normal saline group (2.8%) compared to the ondansetron group (0.7%) and the difference between the proportions was not statistically significant. Conclusion: The study concluded that ondansetron 4 mg intravenously is an effective prophylactic means of prevention of post spinal anaesthesia induced hypotension within and after 30minutes, maintaining statistically significantly better hemodynamic profiles following spinal anaesthesia and also beneficial to reduce the incidence of postoperative nausea, vomiting and shivering compared to normal saline. Keywords: Hypotension, bradycardia, Bezold-Jarisch reflex and Ondansetron

Introduction Axillary brachial plexus block is an anesthetic option used for surgeries of arm, forearm and elbow. The use of USG has significantly improved the quality of nerve blocks by direct visualization of nerves and related anatomical structures, needle trajectory and spread of local anesthesia during injection and significantly increases the success rate. Various drugs like Ropivacaine, bupivacine and Levobupivacaine are preferred due to greater margin of safety. However the efficacy of Levobupivacaine in Axillary Brachial Plexus Block has not been studied much. Therefore ,we designed this study to compare the clinical effect of Ropivacaine with Levobupivacaine for ABPB using USG technique. Methodology It’s a hospital- based Comparative study done in Department of Anesthesiology, AGMC & GBPH from July 2016 to June 2018 (2 years) where 60 patients aged between 18-55 years with ASA grade 1 & 2 who are posted for upper limb surgery were randomly allocated into two groups of 30 each. Patients belonging to ASA grade (3& 4) and age <18years,>55years, Patient with h/o bleeding diathesis, neuromuscular disorder, morbid obesity, prolonged drug therapy & local site infection were excluded from the study. USG guided axillary nerve block performed under aseptic condition. Sensory and motor blocks were assessed in each nerve territory at 2, 5, 10, 15, 20, 25, and 30 mins, 6 hr, 12 hr , 18hr, and 24 hrs after LA injection after LA injection. Onset of block, duration block and quality of analgesia has been compared. For the duration of the study, the presence of hypotension, bradycardia, hypoxia or nausea and vomiting was recorded and treated according to standard clinical practice. Result Among 60 study subjects Mean age was 34.7±12.6 years and majority of the study subjects were males (73.3%) and 26.7% were females. The pre-operative parameters e.g. age, sex, body weight etc. were compared between two groups but there was no statistically significant difference between the two groups (p>0.05). The onset of motor blockade among patients of Ropivacaine group was also shorter than patients received Levobupivacaine which was significant. Duration of sensory blockade was shorter in Ropivacaine group & duration of motor blockade was also shorter in Ropivacaine group than Levobupivacaine group and these difference were found to be statistically significant (p<0.05). There was no significant change in vital parameters after administration of both the drugs when observed at specific time intervals. VAS Scores were comparable in both the groups. Conclusion The following conclusion can be made from the present study • Ropivacaine has faster onset of sensory and motor blockade when compared with Levobupivacaine. • But duration of both sensory and motor blockade was lesser than Levobupivacaine • Ropivacaine provides stable haemodynamic profile similar to Levobupivacaine. • It provides satisfactory intra-operative &post-operative analgesia comparable to Levo