Traditionally Supraclavicular Brachial plexus block is the commonly performed block for upper extremity surgeries. The Problems associated with this technique include inadequate block, failed block, direct injury to the nerves, pneumothorax, phrenic nerve palsy and vascular puncture etc. Recently lateral approach for supraclavicular brachial plexus block is gaining popularity because of its less complications and high success rate. The aim of the study is to compare the efficacy of lateral approach with conventional approach for supraclavicular brachial plexus block. METHODS: Fifty patients of ASA grade I and II scheduled for upper extremity surgery (below the midarm) were randomly allocated into two groups of 25 each. Group C was randomly allocated to receive supraclavicular brachial plexus block by conventional approach. Group L was randomly allocated to receive supraclavicular brachial plexus by lateral approach. Both the groups were given 10ml of 1.5% lignocaine and 15ml of 0.5% ropivacaine (total volume 25 ml).The parameters assessed were the onset and duration of sensory and motor blockade, time taken for the procedure, need for supplementation of anaesthesia, adverse effects, tourniquet tolerance and success rate. Statistical analysis was done using appropriate tests, (p<0.05) was considered statistically significant. We concluded that lateral approach for supraclavicular brachial plexus block using peripheral nerve stimulator, is a better alternative to conventional approach in terms of higher success rate and lesser complication rate. KEYWORDS: Brachial plexus block, Lateral approach supraclavicular brachial plexus block, Nerve stimulator, Lignocaine, Ropivacaine. INTRODUCTION:Brachial plexus block is a popular technique for upper limb surgeries, postoperative and chronic pain management. 1 Supraclavicular brachial plexus block is the common approach used for upper limb surgeries below the mid humerus. 2 The major advantage of supraclavicular block is that, the nerves are tightly packed in this area giving a very fast and deep block. Hence it is called as "The Spinal of the Arm". 3 However this approach has its own complications like direct injury to the nerves, puncture of subclavian artery, pneumothorax etc. 4 Recently lateral approach for supraclavicular brachial plexus block has gained popularity because of its low side effect profile and higher success rate compared to conventional approach. 5 Dr. Dilip Kothari has described this lateral approach for supraclavicular brachial plexus block and demonstrated that it was associated with minimal complications and high success rate.Ultrasound guided nerve blocks are being routinely done now a days, 6 however due to unavailability of ultrasound in our operating rooms, the present study was carried out using a nerve Page 8662 stimulator guided technique. 7,8 The aim of our study was to compare lateral approach with conventional approach for supraclavicular brachial plexus block, in terms of characteristics of sensory and motor blockade, success rate and comp...

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BACKGROUND: Appendectomies and lower abdominal surgeries are associated with significant postoperative pain in children. Transversus Abdominis Plane (TAP) block provides effective analgesia for patients undergoing lower abdominal surgeries. Our aim is to evaluate its analgesic efficacy for lower abdominal surgeries in children when compared to standard systemic analgesia. METHODOLOGY: After institutional Ethics Committee approval, 50 children, ASA I/II 7-13 yrs. undergoing lower abdominal surgeries were randomized into groups A and B of 25 each. All patients received standard General Anesthetic with standard monitoring. In Group A, TAP block was performed under land mark technique with 2.5mg/kg of 0.5% ropivacaine which is equivalent to 0.3ml/kg after General Anesthesia. In Group B, standard systemic analgesia was given which served as the control group. In addition, patients of both groups received regular IV paracetamol 15mg/kg immediately after completion of surgery. STATISTICS AND RESULTS: Statistical analysis was performed with student's t-test and Fisher's exact test. P<0.05 was considered significant. TAP block with ropivacaine reduced mean tramadol requirements in the 1 st 24hrs postoperative period [42+15.89 vs. 80.35+19.16mg; p<0.001]. Postoperative VAS scores significantly reduced in TAP block group until 24hrs after surgery. No complications were reported with TAP block in our study. CONCLUSION: Land mark based TAP block, as a part of balanced analgesia regimen provides superior analgesia than systemic analgesia alone in children undergoing lower abdominal surgeries.

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BACKGROUND: Laryngoscopy and endotracheal intubation is invariable in G.A. and is associated with increased sympathomimetic response. The present study compared the efficacy of esmolol and labetalol in low doses for attenuation of pressor response. MATERIALS & METHODS:This is a Prospective, randomized, placebo controlled study in which 75 ASA Grade I and II patients aged 18-45 yrs. undergoing elective surgical procedures, requiring G.A. and orotracheal intubation were taken up for the study. Patients were allocated to any of the three groups of (25 each). Group C (Control) received 10ml of 0.9% saline IV, Group E (Esmolol) were given 1mg/kg of drug diluted with 0.9% saline 10ml IV, Group L (Labetalol) were given 0.5mg/kg of the drug diluted with 0.9% saline 10ml IV. All the patients were subjected to the same anesthesia technique. HR, SBP, DBP were recorded prior to intubation, then 1 minute, 3 min, 5 min and upto 10min post intubation. RESULTS: Compared to placebo, esmolol and labetalol significantly attenuated HR, SBP, DBP during laryngoscopy and intubation. CONCLUSION: In lower doses, labetalol is a better agent than esmolol in attenuating the sympathomimetic response to laryngoscopy and intubation.