BackgroundMajor abdominal surgeries are often accompanied by excruciating pain, which, if not adequately managed, can reduce patient comfort and satisfaction, delay mobilization, compromise respiratory and cardiac functioning, and increase healthcare costs. The transversus abdominis plane (TAP) block is an efficient and safe complement to multimodal postoperative analgesia for abdominal surgery. This study evaluates the efficacy of combining magnesium sulfate (MgSO 4 ) with bupivacaine for TAP block in patients posted for total abdominal hysterectomy (TAH). MethodologySeventy female patients between the ages of 35 and 60 who were scheduled to have a TAH under spinal anesthesia were divided randomly into two groups of 35 each: group Bupivacaine (B) and group Bupivacaine-Magnesium sulfate (BM). Group B received 18 milliliters (mL) of bupivacaine 0.25 percentage (%) 45 milligrams (mg) with 2 mL normal saline (NS) whereas group BM received 18 mL of bupivacaine 0.25% (45 mg) with 1.5 mL of 10% weight/volume (w/v) MgSO 4 (150 mg) and 0.5 mL NS in the ultrasonography-guided (USG) bilateral TAP block performed after the end of surgery. Groups were compared for the postoperative visual analog scale (VAS) scores, the time required for first rescue analgesia, the number of analgesic rescues at various time intervals, patient satisfaction score, and any side effects. ResultsPostoperative VAS scores at 4, 6, 12 and 24th hour (hr) (p < 0.05) in group BM were lower compared to group B. Time required for rescue analgesia was significantly prolonged in group BM (882.94 ± 70.22 minutes) compared to group B (459 ± 100.53 minutes) with minimal usage of rescue analgesia (p < 0.05) up to 12 hr. In group BM, the patient satisfaction score was higher (p = 0.001). ConclusionIn addition to a considerable reduction in post operative VAS scores and overall use of rescue analgesia, the addition of magnesium to bupivacaine significantly prolongs the TAP block and increases the initial postoperative period of bearable pain.

BackgroundBaska Mask (BM) is a third-generation supraglottic airway device with a self-inflating cuff. This study aimed to evaluate the efficacy of the BM compared to ProSeal laryngeal mask airway (PLMA) regarding insertion time, ease of insertion, and oropharyngeal seal pressure in patients undergoing elective surgeries under general anesthesia for less than two hours. MethodsThis prospective, randomized, double-blind comparative study was done on 64 patients randomly divided into two groups, with 32 patients in the PLMA group (Group A) and 32 in the BM group (Group B). Individuals with a body mass index (BMI) of more than 30, a history of nausea/vomiting, or pharyngeal pathology were excluded from the trial. After induction with propofol 3-4 mg/kg, fentanyl 1-2 mcg/kg, and the neuromuscular blockade was achieved with atracurium 0.5 mg/kg, patients were inserted with either BM (n= 32) or PLMA (n= 32). The primary outcome measure was the time taken for insertion and ease of insertion. Secondary outcome measures included the number of attempts, oropharyngeal seal pressure (OSP), and laryngopharyngeal morbidity (trauma to lips, blood staining, and sore throat) immediately and 24 hours postoperatively. ResultsDemographic data were comparable and statistically insignificant. Regarding time and ease of insertion, the BM could be inserted in a lesser time of 24±1.136 seconds compared to PLMA which took 28.59±1.682 seconds, with a high success rate in the first attempt which was statistically significant. The BM provided a higher OSP (31.34 +1.638 cmH2O) when compared to PLMA (24.81±1.469 cmH2O) and was statistically significant. Complications associated with insertion trauma to the lip, blood staining, and sore throat were more in PLMA (15.6%, 15.6 %, 9.4%, respectively) compared to the BM (6.3%, 3.1%, 3.1%, respectively), and statistically insignificant. ConclusionBM had higher first-attempt successful insertion with better OSP compared to PLMA in patients under controlled ventilation.

IntroductionEnd-tidal capnography (EtCO 2 ) has been the gold standard method for confirmation of endotracheal intubation. Upper airway ultrasonography (USG) is a new promising method for confirming endotracheal tube (ETT) placement and has the potential to become the first-line non-invasive airway assessment tool in the future thanks to widespread POCUS knowledge, greater technology improvements, portability, and availability of ultrasound in the majority of essential areas. Hence our study aimed to compare upper airway USG and EtCO 2 for the confirmation of ETT placement in patients undergoing general anesthesia. AimTo compare the upper airway USG with EtCO 2 for confirmation of ETT placement in patients requiring general anesthesia for elective surgical procedures. The objectives of the study were to compare the time taken for confirmation, and the number of correct identification of tracheal and esophageal intubation by both upper airway USG and EtCO 2 . Materials and methodsAfter obtaining institutional ethical committee (IEC) approval, a prospective randomized comparative study involving 150 patients under American Society of Anesthesiologists (ASA) grade I and II requiring endotracheal intubation for elective surgeries under general anesthesia was randomized into two groups, Group U-upper airway USG and Group E-EtCO 2 with 75 patients in each group. ETT placement confirmation was done by upper airway USG in Group U and by EtCO 2 in Group E and the time taken for confirmation of ETT placement and correct identification of esophageal and tracheal intubation by USG and EtCO 2 was noted. ResultsThe demographic details among both groups were statistically insignificant. Upper airway USG had a faster average confirmation time of 16.41 seconds when compared to EtCO 2 which took an average confirmation time of 23.56 seconds. In our study, upper airway USG was able to identify esophageal intubation with 100% specificity. ConclusionUpper airway USG can be a reliable method and can be employed as a standard method for confirmation of ETT location in patients undergoing elective surgeries under general anesthesia when compared to EtCO 2 .