Background: Epidural anaesthesia is a safe alternative for general anaesthesia in patients undergoing infraumbilical surgeries. This study was conducted to evaluate the effect of clonidine as an adjuvant to levobupivacaine, an S (-) enantiomer of bupivacaine. Material and Methods:Hundred patients of ASA grade I and II undergoing infraumbilical surgeries were randomized in two groups as L and LC. Group L received 0.5% levobupivacaine (1.5mg/kg) and group LC received 0.5% levobupivacaine (1.5mg/kg) with clonidine (2µg/kg). The onset time for sensory, motor blockade, duration of anaesthesia and duration of analgesia, VAS score were observed in both the groups. The haemodynamic variables such as heart rate, systolic and diastolic blood pressure, respiratory rate and SPO2 at various time intervals were measured. Any untoward side effects were noted in both groups. Results:The onset of sensory (7.8±1.7mins) and motor blockade (10.9±1.9mins) was significantly faster in clonidine group. Duration of anaesthesia and duration of analgesia was prolonged in group LC (234.5±16.1mins, 412.8±48.3mins) compared to group L (173.56±12.78 min, 269.2±24.2mins) which was statistically significant (p<0.05). Similarly clonidine group had less VAS score compared to control group. There was no significant change in the haemodynamic variables between the two groups. Hypotension and bradycardia was found more in clonidine group compared to the control group. Conclusion:Clonidine as an adjuvant to levobupivacaine prolongs the post-operative analgesia and the duration of anaesthesia for infraumbilical surgeries.

Today, surgeons across the world have realized the benefits of laparoscopic approach, for short hospital stay, improved postoperative recovery times. Thus, laparoscopic surgeries are being used with greater frequency in health care system. However, laparoscopy is not without complications like, subcutaneous emphysema, pneumopericardium, pneumothorax, gas embolism, visceral injuries. Since, these complications remain a cause of concern, we need better trained anesthesiologist and laparoscopic surgeons. Regular assessment and monitoring should be done to recognize the complication as early as possible and prompt treatment for positive patient outcome. Subcutaneous emphysema is defined as the presence of gas within the tissue, beneath the skin. Here, we describe a case report where the patient developed massive subcutaneous emphysema during laparoscopic ovarian cystectomy.