Background: Anesthetic management practices have advanced to opioid-free anesthesia (OFA) often replacing opioids in oncologic surgeries. The study was conducted to find the quality of recovery (QoR) of patients undergoing breast cancer surgeries receiving OFA.Methods: A double-blinded, randomized controlled study was conducted with 60 patients randomized to group OFA and group OA (opioid anesthesia). Group OFA received one-time dosing of ketamine 0.3 mg/kg, lignocaine 1.5 mg/kg, and dexmedetomidine 1 mcg/kg. Group OA received fentanyl 2mcg/kg. Intraoperatively, Group OFA received dexmedetomidine 0.4 mcg/kg/h and the OA group received fentanyl 0.5 mcg/kg/h infusion. Bispectral index (BIS), hemodynamics, muscle relaxant administration, and sevoflurane concentration were noted. A modified QoR-40 score was used to assess the quality of recovery in the postoperative period.Results: A higher QoR-40 score was found in the OA group (median 182, IQR 178-186) compared to the OFA group (median 180, IQR 178-184). Out of the five components, the patient's emotional state was better in the group OA (39.9±2.77) than in the OFA group (37.9±2.77). The patient's physical comfort was found to be better in the group OFA (52.52±3.23) compared to group OA (50.93±3.23). Physical independence, psychological support, and pain were comparable between the two groups. Patients in group OFA received less sevoflurane, a muscle relaxant, and showed a mild reduction in heart rate and mean arterial pressure (MAP) when compared to group OA. The time taken to reach a Modified Aldrete score of 9 was high in OFA (11.47±2.16) and (9.17±1.09) when compared to group OA. No significant differences were noted with the visual analog score (VAS) score, Ramsay sedation score, and modified post-anesthesia discharge scoring system (PADSS) score. Conclusion:We conclude that the quality of recovery of patients receiving opioid-free methods of anesthesia was not inferior to OA in patients undergoing breast cancer surgeries.

C-MAC D-Blade® (Karl Storz, Tuttlingen, Germany) video laryngoscope (VL) has proved to be of immense utility in difficult intubation. But unfortunately, in an urgent situation, the predictable correct curvature of the endotracheal tube for effortless intubation is not met. We hypothesized that expertise is the most important variable in intubation and that novice students will be unable to intubate if the angle of curvature is incorrect. MethodsAn observational cross-sectional study was planned with 30 anesthesia residents, categorized into three groups based on their expertise in laryngoscopy. Students had to intubate an airway mannequin using the C-MAC D-Blade® VL with three different stylet angulations. The curvatures were 80, 100, and 120 degrees, which are commonly encountered in routine day-to-day practice. The time to get a stable glottic view, time to intubate, and ease of intubation were measured. ResultsThe mean time to intubate was the least with 100-degree angulation in group C (19.60 ± 0.97) while the maximum time was in group A with 80-degree angulation (61.49 ± 3.69). A significant difference was noted in time to get a stable glottic view when compared between the groups. There was no difference in time to intubate with different stylet angulations when compared between groups. ConclusionsNovices and experts could intubate even if the angle of curvature was incorrect taking more time. The time to laryngoscopy is significantly dependent on experience, but the time to intubate is influenced by the angle of curvature of the stylet.

Introduction The ultrasound-guided infraclavicular brachial plexus block by triple-point injection method was aimed at blocking the three individual cords in the infraclavicular region. Recently, a single-point injection method which does not require visualization of cords to produce nerve block has been introduced. This study compared the block onset time, performance time, patient’s satisfaction, and complications between the ultrasound guided triple-point injection and single-point injection methods. Patients and Method This randomized controlled trial was conducted in a tertiary care hospital. Sixty patients were divided into two groups – Group S: 30 patients received single-point injection method of infraclavicular block. Group T: 30 patients received triple-point injection method of infraclavicular block. Drugs used were 0.5% ropivacaine with 8 mg dexamethasone. Results The sensory onset time was significantly longer in Group S (11.13 ±1.83 min) than Group T (6.20 ±1.19min). No statistically significant difference was found between the two groups regarding mean motor onset time. The composite sensorimotor onset time was similar between the groups. The mean time to perform the block was significantly lesser in Group S (1.35 ±0.38 min) when compared to group T (3.44 ±0.61min). The patient satisfaction score, conversion to general anesthesia and complications were not significant among the two groups. Conclusion We concluded that single-point injection method had a shorter performance time and similar total onset time with less procedural complications compared with triple point injection method.

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Background and objectiveLaparoscopic surgeries can result in exaggerated sympathetic responses due to pneumoperitoneum. Many drugs including clonidine and gabapentin have been evaluated to attenuate the hemodynamic response to abdominal insufflation. In light of this, this study was conducted to compare the effects of preoperative administration of oral gabapentin with those of clonidine on intraoperative hemodynamic parameters in patients undergoing laparoscopic surgeries. MethodologyA prospective, randomized, double-blinded comparative trial spanning a period of one year was conducted involving 150 patients scheduled to undergo elective laparoscopic surgeries at a tertiary hospital. Patients who fulfilled the inclusion criteria were randomly allocated into three groups: to receive oral gabapentin 300 mg (Group G) or oral clonidine 150 mcg (Group CL) or a placebo tablet (Group C). Standard anesthetic protocols were followed during the surgery and the mean arterial pressure (MAP), heart rate (HR), postoperative pain as assessed by visual analog scale (VAS) scores, postoperative analgesic consumption, sedation scores, and complications like nausea, vomiting, and dry mouth were recorded and analyzed. ResultsHR and MAP were significantly reduced in the intervention groups (clonidine and gabapentin) compared to the control group. There was a statistically significant reduction in MAP and HR in patients on oral clonidine compared to patients on gabapentin. Postoperative pain as assessed by VAS score was better in the intervention groups compared to patients who were administered a placebo. Postoperative analgesic consumption was significantly lower in patients on clonidine and gabapentin compared to the control group. Patients on oral gabapentin received lower doses of tramadol compared to patients on clonidine. Postoperative sedation as assessed by the Ramsay sedation scale (RSS) score was higher in patients on oral gabapentin. Complications like postoperative nausea and vomiting were significantly reduced in the intervention groups, while dryness of mouth was more prevalent in patients on clonidine. ConclusionBased on our findings, oral clonidine is more effective in attenuating hemodynamic response to pneumoperitoneum compared to oral gabapentin. Postoperative pain was lower in intervention groups compared to the control group. However, patients on gabapentin required a lower dose of analgesics postoperatively compared to patients on clonidine. Postoperative sedation was also more pronounced in patients on gabapentin while dryness of mouth was more common in patients on oral clonidine.