Background: A middle ear surgery (tympanoplasty), is done under various modes of anaesthesia such as local anaesthesia (LA), general anaesthesia (GA) or sedation with local anaesthesia (MAC). It is usually performed under MAC providing advantages of rapid onset, allowing hearing test intraoperatively and early mobilization of the patient. Aims and Objectives: The aim of this study was to compare effectiveness of nalbuphine and propofol with pentazocine and promethazine combination for intraoperative sedation under monitored anesthesia care for tympanoplasty under local anesthesia (LA). Materials and Methods: A total 60 patients undergoing tympanoplasty under LA divided in to two groups randomly to receive either IV nalbuphine (50 mcg/kg) and propofol 750 mcgs/kg in 10 min followed by a maintenance infusion at the rate of 25 mcg/kg/min. Group N or pentazocine 0.6 mg/Kg and Inj. Promethazine 0.5 mg/kg IV diluted in 10 ml normal saline over 10 min followed by 25 mcg/kg/min infusion of normal saline (Group P). Sedation was titrated to Ramsay Sedation Score (RSS) of 3. Vital parameters such as HR, BP, SpO2, RSS, visual analog scale score (VAS), requirement of rescue analgesics, mean bleeding score, and surgeon satisfaction score (Likert Scale) were recorded and analyzed. Results: RSS was higher and VAS score was lower in Group N at 30, 60, 90, and 120 min (P<0.05) that mean bleeding score was lower in Group N as compare to Group P which was statistically significant. Conclusion: Nalbuphine and propofol combination are superior to pentazocine and promethazine combination in terms of producing better analgesia, sedation with batter surgical field.

Introduction: Gabapentin and pregabalin were earlier used as antiepileptics. These have been also found to have analgesic, anticonvulsant and anxiolytic effects. Aim: To compare the pre-emptive use of pregabalin and gabapentin on their opioid sparing effects among patients undergoing laparoscopic cholecystectomy. Materials and Methods: This randomised controlled, singleblind study was conducted in Department of Anaesthesiology at Mahatma Gandhi Medical College and M.Y Hospital Indore, Madhya Pradesh, India, from August 2020 to August 2021. The study included 90 patients of American Society of Anaesthesiologists (ASA) physical status class I/II, undergoing elective laparoscopic cholecystectomy. Patients were allocated randomly into three groups, 30 patients each. Group P receiving tablet oral pregabalin 150 mg, group G receiving oral gabapentin 600 mg and group C receiving tablet multivitamin (control group), before induction of anaethesia. Intraoperative requirement of opioids, sedation score, Visual Analogue Scale (VAS) score, and postoperatively analgesia requirement in the form of opioid were noted. Association between two non parametric variables was done using Pearson Chi-square test. Comparison of means between three groups was done using One-way Analysis of Variance (ANOVA) followed by Posthoc Turkey test. Statistical Package for Social Sciences (SPSS) version 20.0 software was used. Results: The mean age in group P, C and G was 39.73±13.55 year, 38.67±13.33 year and 41.03±5.62 years (p-value=0.726). The mean intraoperative requirement of opioid in pregabalin group was 100 μg, in gabapentin group was 100 μg when compared to control group 150 μg. Postoperative requirement of analgesic was later in pregabalin group (7.23±0.64 hours) compared to gabapentin group (5.78±0.49 hours) and control group (4.37±0.47 hours). Conclusion: Pregabalin and gabapentin have opioid-sparing effect intraoperatively and postoperatively and can be used preemptively as an attractive choice.

Introduction: Tymanoplasty, a middle ear surgery, is done either under Local Anaesthesia (LA), General Anaesthesia (GA) or sedation with local anaesthesia. It is usually performed under Monitored Anesthesia Care (MAC) providing advantages of rapid onset, allowing hearing test intraoperatively and early mobilisation of the patient. Aim: To study the effect of nalbuphine/dexmedetomidine with nalbuphine/propofol on sedation and analgesia in tympanoplasties performed under MAC. Materials and Methods: This randomised, double-blind, clinical study was conducted from June 2020 to June 2021 in the Department of Anaesthesiology at Mahatma Gandhi Memorial Medical College and MY Hospital, Indore, Madhya Pradesh, India. Total 60 adult patients, of American Society of Anesthesiologists (ASA) grade I and II undergoing tympanoplasty under MAC, were randomly allocated into two groups. All patients received injection nalbuphine 50 μg/kg intravenously. Group D received a bolus dose of injection dexmedetomidine 1 μg/kg i.v. over 10 min followed by an infusion at 0.3 μg/kg/h i.v. Group P received a bolus dose of injection propofol 0.75 mg/ kg followed by an infusion at 0.025 mg/kg/min i.v. Sedation and analgesia were titrated to Ramsay Sedation Score (RSS) and Visual Analog Scale (VAS) of 3 each. The vital parameters and need for intraoperative rescue sedation/analgesia were recorded and compared. Results: Mean RSS was significantly more in group D (3.11±0.055) than group P (2.80±0.350). Overall, VAS score was significantly less in group D (1.60±0.670) than group P (2.70±0.691). In group D, 2 (6%) patients and in group P, 4 (12%) patients required inj. midazolam. Similarly, the requirement of inj. paracetamol in group D was in 3 (10%) patients, and in Group P it was 10 (33%) patients. Bradycardia (23.3% in group D and 13.3% in group P) and hypotension (20% in group D and 13.3% in group P) were the major side-effects seen in the study. Conclusion: Nalbuphine/dexmedetomidine is superior to nalbuphine/propofol in producing sedation and decreasing VAS in patients undergoing tympanoplasty under MAC.