BACKGROUND Supraclavicular block provides anaesthesia for upper extremity in the most consistent andf efficient manner of any brachial plexus technique. Adjuvants when added to local anaesthetics enhance the onset and prolongs the duration of block. α2 agonists produce analgesia, sympatholysis and sedation, hence considered as effective adjuvant. The aim of this study is to compare the efficacy and safety of two α2 agonists, i.e. clonidine and dexmedetomidine as an adjuvant for brachial plexus block. MATERIALS AND METHODS It was a prospective, randomised and double-blind study. Sixty patients of ASA grades I and II undergoing forearm surgeries were randomly divided into two groups of 30 patients each. Group C patients received Inj. Bupivacaine (0.5%) 2 mg/kg + Inj. Lignocaine (2%) 5 mg/kg with adrenaline + Inj. Clonidine 1 μg/kg. Group D patients received Inj. Bupivacaine (0.5%) 2 mg/kg + Inj. Lignocaine (2%) 5 mg/kg with adrenaline + Inj. Dexmedetomidine 1 μg/kg. Parameters noted were onset, completion and duration of sensory and motor block, duration of analgesia, Ramsay sedation score, vital parameters and complications if any. Results were analysed by student's unpaired 't' test and chi-square test. RESULTS Onset and time for complete sensory and motor block was significantly faster in the dexmedetomidine group when compared to the clonidine group. The total duration of sensory and motor block and duration of analgesia was also significantly longer in Group D. Both the groups had stable haemodynamics. No complications or side effects were observed in both the groups. CONCLUSION Dexmedetomidine can be used as an adjuvant, alternative to clonidine in supraclavicular brachial plexus block with prolongation of both sensory and motor block, and without any haemodynamic instability and systemic side effects.

BACKGROUND Post-operative pain is a ubiquitous finding following any surgeries. It has physiological and psychological effect in patients. The source and degree of nociceptive stimulation differ among individuals and type of surgeries. In this regard, multimodal analgesic approach has been encouraged for post-operative pain relief, local infiltration of wound site being simplest among them. This procedure reduces the sensitisation and consequent hyperalgesia by cutting down afferent impulses from site of incision and injury. METHODS This is a single blind randomized clinical trial conducted at surgery main operation theatre, surgery indoor wards for a duration of 2 years. 60 patients posted for routine surgeries under general anaesthesia were taken as study subjects and were randomly divided into 2 groups of 30 each. Before skin closure, skin wound site was infiltrated at 1ml/cm according to the following schedule - Group B: received Inj. Bupivacaine plain (0.2 %), Group R: received Inj. Ropivacaine plain (0.2 %). All the patients were followed up for 24 hours and post-operative pain score parameters (Visual Analogue Score) were taken at 1 hour, 2-hour, 6-hour, 10 hour and 24 hours. The time duration till the requirement of first dose of rescue analgesia was noted down. Data was analysed using chi-square test, student t - test and statistical significance was set at P < 0.05. RESULTS Hemodynamic stability was more with Ropivacaine as the fall in blood pressure and heart rate was not drastic. Duration of analgesia was longer with Ropivacaine. Analgesia was better with Ropivacaine. Both the drugs caused analgesia of significant extent. No cardiotoxicity or any other adverse reaction was observed with either drug in this study. CONCLUSIONS Ropivacaine is having longer duration of analgesia and better analgesic effect than bupivacaine. KEYWORDS Postoperative, Analgesic, Wound, Infiltration, Bupivacaine, Ropivacaine

BACKGROUND General anaesthesia is the traditional standard technique for various breast surgery, but Thoracic Epidural Anaesthesia offers advantages like better haemodynamics, early recovery, less postoperative respiratory complications and good analgesia. The objective of this study is to evaluate the effectiveness of Thoracic Epidural Anaesthesia with Dexmedetomidine and Inj. Ropivacaine (0.5%) for breast surgery (MRM) with conventional general anaesthesia. MATERIALS AND METHODS With permission from Institutional Ethics Committee, forty consenting ASA Grades I and II patients posted for MRM were divided into two groups. In Group (TEA) Thoracic Epidural was performed in T4-T8 intervertebral space and 5 cm of epidural catheter was threaded. Inj. Ropivacaine 0.5% with Dexmedetomidine 1 µg/kg was injected into the epidural space in increments via the catheter to achieve the desired height. In Group (GA), patients were managed in conventional way with Glycopyrrolate (0.2 mg), Fentanyl (2 µg/kg) and Midazolam (0.05 mg/kg) for premedication induced with Inj. Propofol (2 mg/kg). Intubation and maintenance of relaxation thereafter was with Vecuronium. Anaesthesia maintained with N20:O2 in 60:40 ratio with Isoflurane 0.4-0.6% in IPPV. Towards the end of surgery, the patients received Ondansetron (4 mg) and Diclofenac (75 mg) infusion and reversed with Neostigmine (0.5 mg/kg) and 20 µg of Glycopyrrolate. Ringer's Lactate was used as maintenance fluid for both the groups. Monitoring of Pulse, NIBP, ECG, SpO2 and Respiration was done throughout surgery in both the groups. RESULTS Adequacy of anaesthesia, surgical condition, bleeding, post-anaesthesia recovery, untoward effects in the perioperative period and overall patient satisfaction were evaluated. CONCLUSION Thoracic epidural with 0.5% Ropivacaine in conjunction with Dexmedetomidine did offer an excellent perioperative outcome without any significant untoward effects.