This study was undertaken to study efficacy of single dose of intravenous magnesium sulphate to reduce post-operative pain in patients undergoing inguinal surgery. One hundred patients undergoing inguinal surgery were divided randomly in two groups of 50 each. The patients of magnesium sulphate group (Group-I) received magnesium sulphate 50 mg/kg in 250 ml of isotonic sodium chloride solution IV whereas patients in control group (Group-II) received same volume of isotonic sodium chloride over 30 minutes preoperatively. Anaesthesia was induced with propofol (2 mg/kg) and pethidine (1 mg/kg). Atracurium besylate (0.5 mg/kg) was given to facilitate insertion of LMA. Pain at emergence from anaesthesia and 2, 4, 6, 12 and 24 hours after surgery was evaluated. The timing and dosage of rescue analgesic during first 24 hrs after operation was noted. Pain in postop period was significantly lower in magnesium sulphate group in comparison to control group at emergence from anaesthesia and 2, 4, 6, 12 and 24 hrs postop [1.86 vs. 1.96 (P=0.138), 1.22 vs. 1.82 (P=0.001), 1.32 vs. 1.88 (P=0.000), 2.74 vs. 3.84 (P=0.000), 1.36 vs. 2.00 (P=0.000) and 0.78 vs 1.30 (P=0.000), respectively]. Patients in group-I were more sedated as compared to group-II [sedation score 1.86 vs. 1.40 (P=0.000)]. Rescue analgesia requirement postoperatively in first 4, 8 and 16 hrs was significantly lower in patients of group-1 than in group- II [1.9 vs. 3.8 (P<0.05), 25.50 vs. 52.50 (P<0.05) and 0.000 vs. 7.5 (P<0.05)]. Preoperative magnesium sulphate infusion decreases postop pain and requirement of rescue analgesia.

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A 55-year-old Indian lady presented to the emergency department with a history of fever and breathing difficulty for the last four days. She had a recent history of admission (four days prior) in a local hospital for recurrent syncope attacks, breathing difficulty, chest heaviness and giddiness and on evaluation was found to have complete heart block on electrocardiogram (ECG) for which permanent dual chamber cardiac pacemaker was implanted through the right subclavian vein. Her chest radiograph (A-P view) done at the local hospital show bilateral chest infiltrates and also the pacemaker leads were seen on the left side of the chest [ Fig-2b]. Her medical history included type 2 diabetes mellitus and hypertension for which she was on regular medicines for past 4 years. She was admitted to the Intensive Care Unit (ICU) for the management of the sepsis due to clinical evidence of pneumonia. On examination, she was drowsy but arousable, moving all limbs, following simple commands with no nuchal rigidity and both pupils equal in size and reacting to light. Her blood pressure was150/80mmHg, pulse 120/minute, random blood sugar 300mg%, no pedal oedema, normal jugular venous pulse, chest-bilaterally clear, heart sounds normal. Her liver function tests, renal function test was normal with leukocytosis. Her echocardiogram showed pacing leads in the right atrium and ventricle with a dilated coronary sinus and left ventricle ejection aBstRaCt Persistent Left Superior Vena Cava (PLSVC) is a rare congenital vascular anomaly (incidence of 0.3-0.5% of the general population) which being mostly asymptomatic in its presentation, is usually detected incidentally. There are many practical clinical implications associated with it including arrhythmias. We report a rare case of PLSVC with absent Right Superior Vena Cava (RSVC) (isolated PLSVC), in a 55-year-old lady who had complete heart block followed by sepsis and was diagnosed to have this condition during the permanent cardiac pacemaker implantation and central venous catheter insertion showing an abnormal path of the catheter/pacing leads. The authors also give an insight into its clinical relevance.