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Background:There is limited data to predict the course of sub-arachnoid block in poliomyelitis patients with scoliotic spine. So we intended to study the course of intrathecal anaesthesia in these patients in comparison to patients with normal spine using 0.5% bupivacaine (heavy).Methods:In this prospective observational study, 41 poliomyelitic patients scheduled for lower limb corrective surgeries under spinal anaesthesia were enrolled. Patients were studied in two groups (Scolotic spine, n=20; Normal spine, n=21). All patients were injected 2 ml of 0.5% bupivacaine heavy intrathecally in the sitting position. The extent of block, bilateral spread, regression of sensory block and motor block were recorded. Demographic data were analysed using the unpaired t test or the chi square test as applicable. Block characteristics were analysed using the Mann Whitney U test.Results:There was statistically significant difference in bilateral spread of sensory block in between the groups. However, there was no significant difference in the maximum extent of the sensory block and the time taken for two segment regression of sensory block. There was no significant difference in time taken to reach complete motor block and for complete recovery from motor block to its preoperative value.Conclusions:Bilateral symmetrical spread of local anaesthetics through intrathecal route cannot be predicted accurately in patients with scoliotic spine. Spinal anaesthesia can be safely administered in poliomyelitis patients with scoliosis with less adverse effects.

A 75-year-old patient who presented with a fractured femur neck was posted for surgery. His previous medical records revealed that he was a known case of dilated cardioyopathy and chronic kidney disease, stage III. He was hospitalized and he had received treatment for the same problem, 6 months back. After admission, the patient was subjected to the required investigations and his laboratory reports revealed; random blood glucose of 148 mg/ dL, urea-84mg/dL, serum creatinine 3.0 mg/dL, serum sodium 127mmol/L, serum potassium 5.8 mmol/L, and Hb 8.0 gm/dL. Heart rate was 37/min and it was regular. Systolic and diastolic blood pressures were 170 mmHg and 60 mmHg respectively. His respiratory rate was 18/min. SOB was class 2. On auscultation, normal vesicular breaths and no added sounds were heard. The pre-operative ECG showed supraventricular bradycardia, abnormal left axis deviation, left ventricular hypertrophy with repolarization abnormality and a complete heart block. Echocardiography reports revealed; global hypokinaesia, severe LV systolic dysfunction, ejection fraction of 20%, Grade 1 diastolic dysfunction, mild mitral regurgitation, tricuspid regurgitation and pulmonary arterial hypertension. Left atrium was 33mm, left ventricle was 65/60, IVSD was 11/11, PWD was 8/12, RV =200mm, MV=2+mr, AOV= 1+AR, AJV=180cm/sec. 2+ TR RVSP =40+RAP, PJV were normal. All valves were normal. He was on treatment with telmisartan 40mg and lasilactone. His chest X-ray revealed enlarged cardiac borders [Table/ Fig-1]. Cardiologist advised biventricular pacing, but the patient was not willing to undergo the same pre-operatively. However, the procedure was planned at the time of surgery, after taking a high risk consent. Regional anaesthesia was planned, it was particularly Graded as epidural and the reason for selection was explained to the patient, which is a routine practice in our institute. Epidural anaesthesia was chosen as it produces changes in the preload and afterload, that mimic pharmacological goals in the treatment of this disease [1]. Epidural anaesthesia also produces minimal effects on the heart rate, and contractility. Blood volume was maintained with colloids at 1.0ml/kg/hr. Intraoperatively, there were no haemodynamic changes [Table/ Fig-2]. Invasive monitoring was done by assessing intraarterial blood pressure, arterial oxygen saturation (sPo 2 ) 5 lead ECG monitoring. CVP line was placed for assessing the volume status. Pre-operatively, anaemia was corrected by transfusing packed cells. Under aseptic preparations, epidural space was identified at L3-L4 by using loss of resistance technique and an 18 G epidural catheter was advanced and it was fixed at 9 cm. 2% lignocaine and 0.5% bupivacaine were given alternately (3 ml), to attain a sensory level of upto T10. Total dose which was required was 10ml. After 10 minutes, the patient was positioned for surgery in supine position, on a surgical table. Intra operatively, epidural infusion of bupivacaine 0.5% was started, at a rate of 5ml/hr. Inotropes (dobutamine, do...

Materials and Methods: A total of 263 knees, (150 patients), males 65, females 85 with early OA were divided randomly into two groups. Group A 75 patients (134 knees) received a single injection of PRP, group B 75 patients (129 knees) received 2 injections of PRP 3 weeks apart. PRP with a platelet count 5 times that of baseline was administered in all. Clinical outcome was evaluated using the Western Ontario and M cM aster Universities Arthritis Index (WOM AC) questionnaire before treatment and at 1 month, 3 month, and 6 months post injection. A reduction in WOM AC score is suggestive of improvement in patient condition. Results: significant improvement in all WOM AC parameters was noted in groups A and B within 3 to 4 weeks and lasting until the final follow-up at 6 months. The mean WOM AC scores (pain, stiffness, physical function, and total score) for group A at baseline were 15.8, 6.22, 43.09, and 65.11, respectively, and at final follow-up were 4.83, 1.00, 14.12, and 19.95, respectively, showing significant improvement. Similar improvement was noted in group B (mean WOM AC scores at baseline: 16.51, 6.91, 41.98, and 65.38, respectively; mean WOM AC scores at final follow up: 5.50, 1.12, 13.69, and 20.37, respectively . The 2 groups were compared with each other, and no improvement was noted in group B as compared with groups A (P, value 0.77). Conclusion: Autologous PRP infiltration in early Osteoarthritis of Ahlback's radiological grading does give relief from pain, stiffness and improves functionality without any major side effects. Double dose doesn't offer any additional advantage.