BACKGROUNDSpinal anaesthesia plays an important role of alleviating pain intraoperatively, extending into post-operative period also. Many drugs have been tried in search for an ideal adjuvant like opioids, soda bicarbonate, ketamine, neostigmine and midazolam. The magnesium sulphate with different mode of action prolong the Bupivacaine-Fentanyl spinal anaesthesia.

BACKGROUNDThe aim of this study was to assess the effectiveness of the administration of fentanyl and midazolam in spinal anaesthesia for lower abdominal gynaecological surgeries. MATERIALS AND METHODS75 patients were recruited to receive either 3.5 mL of 0.5% hyperbaric bupivacaine +20 µ of fentanyl (Group F) or 3.5 mL of 0.5% hyperbaric bupivacaine + 2 mg of midazolam (Group M) or 3.5 mL of 0.5% hyperbaric Bupivacaine + 0.4 mL of normal saline (Group S). RESULTSThere were no significant differences in the highest analgesic level between the groups. Two segment regression time was prolonged in adjuvants Group F and Group M when compared to Group S (p < 0.00001 for Group F and p < 0.0001 for Group M). Duration of analgesia was significantly prolonged with adjuvants with Group F and M than with Group S (129.4 mins. Vs 233.8 for Group F and 187 for Group (M) P < 0.0001). Group F and M showed significantly lower median VNS pain scores than Group S (0 Vs 3, p -0.004). There were no significant differences in the incidence of nausea, vomiting, hypotension, bradycardia, urinary retention. No patient developed respiratory depression or PDPH. The patient's satisfaction of spinal anaesthesia was 100% with Group F and M and 80% in Group S. Fentanyl is a phenylpiperidine derivative, synthetic opioid agonist that is structurally related to meperidine. As an analgesic, fentanyl is 75 to 125 times more potent than morphine. Fentanyl has a more rapid onset and shorter duration of action. Rapid onset is due to its high lipophilicity and shorter duration of action is due to its rapid redistribution to inactive sites, such as fat and skeletal muscles; 75% of initial fentanyl dose is undergoing first-pass pulmonary uptake. Fentanyl in continuous infusion causes progressive saturation of inactive tissue site. As a result, plasma concentration of fentanyl does not decrease rapidly. So the duration of analgesia may be prolonged in infusion. CONCLUSION

BACKGROUNDAnalgesia, one of the components of triad of anaesthesia, has now extended to relief of postoperative pain, chronic pain and cancer pain. The spinal route of analgesia plays an important role in the intra and postoperative period. Effective postoperative analgesia reduces postoperative morbidity, allows early ambulation and discharge. MATERIALS AND METHODSThis study was done in 100 patients who belonged to ASA grade I & II with age of 20-60 years and underwent elective infraumbilical surgeries. After thorough aseptic precaution, L1-L2 or L2-L3 space located and using a 16 gauge Huber point Tuohy needle, epidural space was identified with loss of resistance technique. Through the epidural catheter, a test dose of 2 mL of 1% lignocaine with 10 micrograms of adrenaline was injected and finally the total dose of 15 mL of 0.5% bupivacaine with injection nalbuphine was injected through the catheter and the patients were positioned for the surgery. The pulse rate, blood pressure, respiratory rate were monitored every 5 minutes. Continuous oxygen saturation monitoring was done. At the end of surgery, patients were observed in the recovery room and in the postoperative ward. The level of consciousness assessed ever ½ hour and graded according to the sedation score. Patients were asked to mark a point scale on the 10-point visual analogue scale of pain according to the intensity of pain. The observation was done every 30 minutes. The pain relief is graded according to VAPS. OBSERVATION AND RESULTSPatients in both groups were comparable in age, duration, the site and type of surgery and baseline parameters at the starting of procedure. There were statistically no significant differences between mean age distribution, surgery performed, duration of procedure and baseline parameters in both groups. In this study, rapid onset in group A patients is due to synergistic effect of nalbuphine and bupivacaine. In case of time of onset of motor block, the actual difference between the mean is 5.04 -the study is significant (P<0.000). In the group A, the regression time was the range of 60-83 minutes with the minimum VAPS was 1 and maximum 3. Hence, the quality of analgesia was fair in 30 (85.7%) patients and good in 5 (14.3%). In the group B, the regression time was the range of 54-84 minutes and the quality of analgesia was not assessed since all of them received postoperative narcotic supplementation after the surgery. Hence, the mean duration of surgery was 61.48 minutes, and 63 minutes in Group B. In Group A, patients had sedation score with mean of 0.46 (p value 0.000) which is statically significant. In Group B, all patients were awake. There is significance in BP maintenance in group A, whereas in group B it falls below the baseline value after 5 minutes and 15 minutes and then raises after 30 min. and 45 minutes. No hypotension occurred in group A and in group B. CONCLUSIONIn our study, the epidural nalbuphine hastens the onset of both sensory and motor blockade and significantly prolonged the duration of ...

BACKGROUNDBrachial plexus block in supraclavicular approach is a very good postoperative analgesia. Midazolam, a water-soluble benzodiazepine has been used by various routes to prolong analgesia. The analgesic efficacy of midazolam with bupivacaine in brachial plexus block produces significantly faster onset of sensory and motor blockade and prolongs the duration of sensory and motor block and duration of analgesia.The aim of this study is to compare the effectiveness of addition of midazolam as an adjuvant to bupivacaine in supraclavicular approach of brachial plexus block in upper limb surgery.