Background Percutaneous Nephrolithotomy, widely used procedure by urologists for removing renal stones nowadays. Generally, it is preferred in general anesthesia but here in our study we have compared it with spinal anesthesia to know its safety and efficacy.Material and Methods Sixty patients of either sex, aged between 20-60 years, ASA – Grade I and II, with stones size larger than 15 mm posted for Percutaneous Nephrolithotomy were randomly selected. Patient was divided in two groups 30 each, Spinal Anesthesia (S) and General Anesthesia (G). Patient’s stones sizes, numbers & location, Anesthesia duration, Surgical duration, Recovery duration, Blood loss and Blood transfusion, Analgesic demand, post-operative Nausea & Vomiting, Patient satisfaction, Hospital stays and Heart Rate and Mean arterial pressure between two groups were compared.Results There was no significant difference in terms of mean age, weight, stones sizes, and numbers and its location. The p value for Anesthesia duration and surgical duration were 0.144 and 0.22 which was insignificant. Recovery duration (p-value 0.007), Blood loss (p-value 0.004) were significantly lesser in spinal anesthesia group. There was no significant difference in nausea and vomiting, patient satisfaction when compared between two groups. But Analgesic demand, Blood Transfusion and Hospital stays significantly found to be decreased in spinal anesthesia groups (p<0.05). The mean of MAP showed no significant difference except in 10 and 20 minutes.Conclusion Spinal anesthesia tends to be as effective as general anesthesia for PCNL and beneficial in terms of recovery duration, blood loss, analgesic demands, hospital stays, hence decrease the cost of patient. Journal of Nobel Medical CollegeVolume 5, Number 1, Issue 8, January-July 2016, Page: 37-42

Background: Low back pain with or without radiculopathy is most common presentations of chronic pain. Caudal epidural steroid injection is one of the treatment modalities of this type of pain syndromes. Materials and Methods: The study was conducted in 100 patient who presented in our pain clinic. These patients were given caudal epidural steroid injections under fluoroscopy guidance with 60 mg depo-methylprednisolone added to 0.5% lignocaine making a volume of 10 ml. All these patients were asked to follow up at pain clinic at 1 month, 3 months & 6 months to assess the visual analogue scale (VAS) score, Oswestry disability index (ODI), Straight leg Raise test (SLRT) & Patient satisfaction scale. Results: There was significant reduction in VAS score in one month, three months and six months follow up after caudal epidural steroid injection. The 50% reduction in pain was seen in 72 patients, 69 patients and 62 patients in one month, three months and six months respectively. The mean VAS score were 7.84 before pre-injection, 4.32 at one hour, 4.06 at one month, 4.18 at 3 months and 4.64 at 6 months after the procedure.The mean ODI were 35.16 before pre-injection, 32.12 at one hour, 28.14 at one month, 28.57 at 3 months and 28.68 at 6 months after the procedure. Conclusion: Caudal epidural steroid injections causes significant relief in pain symptoms of backache with or without radiculopathy and increases the quality of life.

Introduction: The major purpose of the Minimal Access Surgery is to reduce the number and size of scars, decrease pain and rate of infections, reduce complications, and improve cosmetic effect. In order to achieve scarless surgery there was a development of the Natural Orifice Transluminal Endoscopic Surgery (NOTS), which did not gain popularity and induced growing interest to single-incision laparoscopy as a modern technique with minimal visible scars.  Objectives: The objective of this study is to correlate worldwide experience with outcomes of Single-Incision Laparoscopic Surgery (SILS) in our institute.  Methodology: A retrospective analysis was done for 9141 patients who underwent Laparo-endoscopic single-site surgery between the year 2011-2020 years (AD). The type of surgery, gender, age, operative time, conversion and complication rate were reported.  Results: Laparo-endoscopic single-site surgery was performed for 9141 patients, with a mean age of 46.3 years (range=2.5- 90). Out of 9141 patients included in this study, 8668 patients underwent Cholecystectomy, 232 underwent simultaneous, 161 appendectomy, 54 ovarian cystectomy, 11 underwent myomectomy, 8 diagnostic laparoscopy and 7 cases of salpingo-oophorectomy. The mean operating time was 19.5 minutes (range=4-35 min). In our study complicated cases were 0.996%, conversion done for 0.1% and mortality was 0.02%.  Conclusion: The advantages of single access surgery include better cosmetic effect, reduced bleeding, infections, herniations and hospital stay.

Background: Brachial plexus block is the technique where in local anesthetic is being injected along the plexus for upper limb surgery. It is widely used and has replaced general anesthesia in day care surgery. Methods: A retrospective study with 124 patients who were administered brachial plexus block were reviewed in order to see its outcomes and suitability. In this study, the area of surgery, type of pathology, duration of surgery, approach of brachial plexus block, nerve block localization technique, effects of blocks and its complications if any were studied. Results: The youngest age group was 16 years whereas oldest was 70 years. The most common area of surgery was on forearm with 73 patients whereas least common site was on shoulder with 9 patients. The supraclavicular block was the most used approach with 76 patients, Interscalene approach in 34 patients whereas axillary approach with 14 patients. Nerve stimulation was used in 82 patients whereas paraesthesia technique was used in 42 patients. Successful block was seen in 98 patients whereas failed block in 8 patients. Only one patient had pneumothorax, beside this there was no other complications noted within this study period. Conclusion: Brachial plexus block if administered with an expert hand found to be always effective with less or no complications and is one of the popular peripheral nerve blocks being practised by an anesthesiologist for upper limb surgery.

Introduction: The use of intrathecal adjuvants in spinal anaesthesia in enhancing and prolonging it’s action has been well established and is widely used for surgery below the umbilicus. Dexmedetomidine, a selective α2A receptor agonist is a suitable adjuvant due to its selective activity. Objectives: To evaluate the effect of a single bolus dose of intravenous dexmedetomidine as an adjuvant in cases undergoing lower limb surgeries under spinal anaesthesia. Methodology: One hundred patients posted for lower limb surgery under spinal anaesthesia with hyperbaric bupivacaine, were equally divided into two groups. In group D, in addition to spinal, intravenous dexmedetomidine 0.5mcg/kg over 10 min was given whereas group C patients received spinal and intravenous normal saline . Results: The onset of sensory and motor block was faster in group D (2.09 ± 0.71 min, 3.18 ± 1min)compared to group C (3.5 ± 0.82 min, 6.19 ± 1.87 min) which was statistically significant . The duration of sensory and motor block was also significantly prolonged in Group D (174.5 ± 14.04 min, 133.4 ± 10.42 min) as compared to Group C(138.2 ± 11.51 min, 120.4 ± 8.8 min).The duration of analgesia in Group D (225.3 ±20.11 min)was prolonged when compared to Group C (168.3 ± 15.11). Conclusion: Intravenous dexmedetomidine as a single bolus dose before spinal anaesthesia can fasten the onset of sensory and motor block, prolongs the duration of sensory and motor block and also increased the duration of analgesia.