BACKGROUND Ropivacaine, a long acting amide local anaesthetic, has reduced potential for neurotoxicity and cardiotoxicity and is considered to block sensory nerves to a greater degree than motor nerves. In today's world, faster recovery along with minimal side effects and early ambulation after surgeries under spinal anaesthesia are very important. So, this prospective randomized study was aimed at evaluating and comparing the efficacy and safety of intrathecally injected isobaric ropivacaine and intrathecally injected hyperbaric bupivacaine in patients posted for lower abdominal surgeries under spinal anaesthesia. METHODS 90 patients belonging to ASA physical status I & II scheduled for lower abdomen surgeries were randomly selected for the study and were divided into two groups of 45 each. Group B received 3 ml of 0.5% hyperbaric (15 mg) bupivacaine intrathecally. Group R received 3 ml of 0.75% isobaric (22.5 mg) ropivacaine intrathecally. Onset and extent of sensory block, onset and duration of motor block, maximum height of sensory block, duration of analgesia, hemodynamic parameters and adverse effects if any were studied. SPSS 20.0 and GraphPad Prism 6.0 were used for the analysis of the data. RESULTS The mean time for onset of sensory block was significantly faster in group B as compared to group R (8.28±2.2 min v/s 7.98±2.2 min). There was no significant difference between the groups regarding the time for two segment regression. Mean time of onset of motor block was significantly faster in group B. The mean duration of motor blockade was 146.89±14.11 min in group R and 208.91±14.62 min in group B. The mean duration of analgesia was comparable in both the groups. Hemodynamic parameters and side effects were comparable in both the groups. CONCLUSIONS 0.75% isobaric ropivacaine provided similar duration of analgesia with a shorter duration of motor block as compared to hyperbaric 0.5% bupivacaine and it also provided adequate level of sensory block for the surgery with minimal intraoperative and postoperative side effects and stable haemodynamics throughout the surgery.

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BACKGROUND Major surgeries like hip arthroplasty, knee arthroplasty etc.; are associated with excessive bleeding. Uncontrolled bleeding can lead to increased morbidity and mortality and may necessitate blood transfusions. This prospective, randomized study was designed to evaluate the efficacy and safety of injection tranexamic acid in reducing blood loss and rate of blood transfusion in lower limb orthopaedic surgeries without tourniquet under subarachnoid block. METHODS After approval from institutional ethical committee, the study was carried out on 80 patients who were divided into two groups of 40 patients each. Patients in group T received a bolus dose of 10 mg/Kg injection tranexamic acid 10 minutes before induction of anaesthesia and patients in group C received 0.9% 10 ml normal saline. Intraoperative and postoperative blood loss were recorded and added together for total blood loss. Postoperative haemoglobin and haematocrit were evaluated 24 hrs. after surgery. The number of patients who received blood transfusion and the number of units of blood transfused postoperatively were recorded. Early adverse reactions of tranexamic acid were recorded and treated. p<0.05 was considered significant. RESULTS Mean intraoperative blood loss in group C (489.75+123.63 ml) was more than group T (450 + 138.66 ml) (p> 0.05). Postoperative blood loss was significantly less in group T (163.67 ± 44.13 ml) as compared to group C (205.43 ± 63.31 ml) (p<0.05). The mean total blood loss was significantly less in group T (613.67 ± 167.40 ml) as compared to group C (695.2 ± 162.44 ml) (p< 0.05). The drop in postoperative haemoglobin and haematocrit was significantly higher in group C as compared to group T (p < 0.0001). Significantly higher number of patients in group C (15) received postoperative blood transfusion as compared to group T (7) (p< 0.05). Acute adverse effects of tranexamic acid and complication of blood transfusion were not seen. CONCLUSIONS Injection tranexamic acid in a bolus dose of 10 mg/Kg is an effective and safe strategy to reduce blood loss and to minimise the rate of blood transfusions in lower limb orthopaedic surgeries without tourniquet under spinal anaesthesia.

Introduction: Sedation is important in the care of the critically ill and postoperative patients. Amount of drug and duration for which it is given, is important in determining patient outcome. Aim: Study aimed to compare the safety and efficacy of injection midazolam and injection dexmedetomidine for sedation in postoperative patients of oromaxillofacial surgery with endotracheal tube in-situ, on spontaneous ventilation in ICU. Methodology: This prospective, randomized, comparative study was conducted on 60 patients undergoing oromaxillofacial surgery who were randomized in two groups of 30 patients each. Group D received injection demedetomidine loading dose of 1μg/kg over 15 minutes, followed by infusion at the rate of 0.2-0.7µg/kg/hr (microgram/kilogram/hour) and Group M received injection midazolam loading dose of 0.05mg/kg over 15 minutes followed by maintenance infusion at the rate of 0.02-0.06mg/kg/hr (milligram/kilogram/hour). The monitored indices included heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, SpO2 and Ramsay sedation score at the start of sedation when the Ramsay sedation score (RSS) was I and time to extubation after stopping sedation. Results: Target sedation range was achieved in a mean duration of 10.36 ± 3.05 minutes in dexmedetomidine group and that in midazolam group was 7.43±2.06 minutes. Highest value of RSS score in dexmedetomidine group was 2.43±0.50, which was observed at the 4th and 10th hour whereas in midazolam group it was 2.83±0.38 which was observed at 6th hour of the study period. Total dose of rescue analgesic required was more in midazolam group as compared to the dexmedetomidine group. The mean duration of extubation after cessation of sedation was 33.27±11.37 minutes in dexmedetomidine group and 49.43±5.58 minutes in midazolam group. Conclusion: Injection dexmedetomidine is better as compared to injection midazolam for postoperative sedation.

BACKGROUNDPost-operative pain frequently hampers implementation of day care arthroscopic knee surgery in spite of so many analgesic, local anaesthetic drugs and routes of administration. The aim of this study was to evaluate the efficacy and safety of intraarticularly administered inj. ropivacaine 0.25% 20 ml, after arthroscopic knee surgery performed under spinal anaesthesia, for prolonging the duration of postoperative analgesia. METHODSThis is a prospective randomized study conducted among 80 patients of both sexes, of American Society of Anesthesiologists, physical status I and II, undergoing day care arthroscopic knee surgery who were randomly assigned into two groups (R, C). Group R received 20 ml of 0.25% ropivacaine, whereas group C received 20 ml of 0.9% inj. normal saline through intra-articular route at the end of the procedure. Pain was assessed using visual analog scale (VAS) and paracetamol given as rescue analgesic when VAS >4. Time of first analgesic request and total rescue analgesic were noted. RESULTSTime for the requirement of first post-operative rescue analgesia (255.15±26.35 vs. 92.40±12.54) min and total mean rescue analgesic requirement was (1.32±0.52 vs. 3.0±1.0) in group R and C respectively. Group C had higher mean VAS score throughout the study period. No side effects were found among the groups. These two results were clinically and statistically significant (p<0.05). CONCLUSIONSAdministration of intra-articular inj. ropivacaine 0.25%, 20ml, is effective & safe method of management of postoperative pain in patients undergoing arthroscopic knee surgeries, as it prolongs the duration of postoperative analgesia, provides better quality of analgesia with reduced requirement of rescue analgesia without significant side effects.