Background: Arthroscopic ACL reconstruction surgery is commonly performed as an outpatient procedure and is often associated with postoperative pain. Objectives: We aimed to find out the effects of intra-articular ropivacaine-morphine on postoperative pain in patients undergoing elective arthroscopic ACL reconstruction surgery. Materials and Methods: A total of 46 patients undergoing elective arthroscopic ACL reconstruction under spinal anaesthesia were enrolled. The participants were allocated to two groups to receive the following intra-articular medications after completion of the surgery and before deflation of the tourniquet: Group I, 20 mL of saline, Group II, 0.25% Ropivacaine and 5 mg morphine 20 mL in volume. Visual analogue scale (VAS) values were recorded at 1, 3, 6, 12 and 24 hours postoperatively, duration of analgesia, total analgesic consumption, and number of rescue analgesia at 24 hours were evaluated. Results: VAS was significantly higher in group I in comparison to other groups. Duration of analgesia was significantly longer in Group II than in Group I. Number of rescue analgesia and total analgesic consumption at postoperative hour 24 was significantly fewer in group II. Conclusions: Intraarticular ropivacaine-morphine combination provides effective pain relief, longer analgesic duration, and less analgesic requirement when compared with intra-articular ropivacaineclonidine combination and saline after arthroscopic ACL reconstruction surgery.

Aim: Outcome of precontoured locking plates fixation in Distal Humerus Fractures. Material and methods: Twenty-five patients with distal humerus fractures were treated with ORIF with pre-contoured locking plates. There were 16 males, 9 females, with an average age of 42.8 years (21-59years). As per the AO classification performance score, the results obtained were graded as excellent or good results in 24 patients (96%), fair in 1 (4%) and poor in 0 (0%) of cases. Average time interval between admission and surgery was 3.8 days (average 1, there were 3 type A fractures(12%),1 type B(4%) and 21 type C fractures (84%).In addition to clinical examination, functional results were evaluated using the Mayo elbow performance score (MEPS). Results: Using the Mayo elbow -9 days). All the fractures as well as the olecranon osteotomies united by 10-16 weeks (13.76 weeks). No patient had deep infection, implant failure, non-union of fracture site or olecranon osteotomy site. Superficial wound infection, which occurred in 2 (8%) patients, resolved with oral antibiotics. Transient ulnar nerve palsy developed in 1(4%) case. However, the patient recovered with conservative treatment. Conclusions: An anatomically precontoured distal humerus locking plates are useful in providing stable fixation of distal humerus fractures, thereby facilitating early postoperative rehabilitation.

Introduction: Osteoarthritis of knee is more common among all types of arthritic conditions. High tibial osteotomy is an accepted surgical technique for treatment of medial compartment arthrosis of knee in younger patients. Selection of the appropriate patients, extensive pre-operative planning and accurate surgical technique are essential for successful outcome. The methods of high tibial osteotomy include open wedge osteotomy and closed wedge osteotomy, the later procedure being more popular. Aims and Objectives: To assess the functional outcome among patients undergoing high tibial osteotomy. Methodology: A hospital based prospective interventional study was done on 30 patients of osteoarthritis with varus deformity. For all the 30 patients after a proper preoperative assessment the surgical intervention in the form of high tibial osteotomy was done and the outcome was evaluated using knee society scoring system. Results: Among the study population 73.3% of the patients had grade III type of osteoarthritis and only 26.6% had grade IV type of osteoarthritis based on Kellgren and Lawrence type of classification. The mean knee score and the mean functional score of the patients before surgery were 54.6 and 53.9 respectively and post operatively at the end of 12 months the knee score and functional score was 83.1 and 82 respectively. A statistically significant improvement was seen in both the knee society score and the functional score. Conclusion:The main improvements seen in this study was the increase in the knee score and functional score after high tibial osteotomy for the patients of osteoarthritis with varus deformity. Appropriate patient selection, proper osteotomy types and precise surgical techniques are essential for the success of high tibial osteotomy.

Background: Intense bleeding during general anesthesia is the major limitation during functional endoscopic sinus surgery. It affects operative eld visibility and increases complications. Hypotensive anesthesia is preffered to improve surgical outcomes. This study aimed to compare the efcacy of propofol and dexmedetomidine infusion for hypotensive anesthesia in patients undergoing FESS. To compare the efcacy Objective: and safety of dexmedetomidine and propofol for hypotensive anesthesia in functional endoscopic sinus surgeries. This Materials and methods: prospective randomized trial was conducted in 60 adult patients who were scheduled for FESS under general anesthesia. Patients were randomly divided into two groups: group P (n = 30) received propofol infusion of 50–150mcg/kg/min and group D (n = 30) received dexmedetomidine with a loading dose of 1 mcg/kg diluted in 10 mL 0.9% saline to be infused over 10 min after induction, followed by maintenance infusion of 0.4–0.8 mcg/kg/h. The infusions were titrated to maintain mean arterial pressure (MAP) between 60 and 70 mm Hg and hemodynamic stability. Intraoperative blood loss, quality of the surgical eld (Fromme- Boezaart scale), hemodynamic control, and patient recovery were recorded. Results: In our study, the mean arterial pressure and heart rate were signicantly lower in group D throughout the surgery than in group P. Blood loss was signicantly higher in group P (105.82 ± 15.16 ml) than in group D (90.50 ± 16.78 ml). The Fromme's score (Surgical eld visibility) 1/2/3 was comparable between the groups. The awakening time was signicantly short in group D than group P. Intraoperatively, only one incidence of bradycardia and hypotension was observed in group D (2.5%) compared to that in group P, which was managed successfully. In our Conclusion: study, we observed that both dexmedetomidine and propofol are efcacious and safe drugs for achieving controlled hypotension during FESS; however, dexmedetomidine provides better hemodynamic control and is associated with lesser degree of sedation without any signicant adverse effects.

Background: Almost every patient undergoing a major surgical procedure will experience some degree of physiologic alteration in lung function. A postoperative pulmonary complication is dened as any respiratory complication that occur within 48-72 hours following a surgical procedure. The relationship between preoperative variables and postoperative pulmonary complications in surgical patients has been the subject of numerous studies. Development of POPC is due to a combination of factors, including surgical pathology and existing comorbidities, as well as surgical and anaesthetic management in the perioperative period. The main risk factors that have been associated with postoperative pulmonary complication are smoking, chronic obstructive pulmonary disease, advanced age, site and duration of surgery, obesity and comorbidity.