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Introduction: The Transversus Abdominis Plane (TAP) block is a relatively simple technique that provides analgesia that, as part of a multimodal analgesic treatment, may be useful in the prevention of postoperative pain. Ultrasound (USG) versus Peripheral Nerve Stimulator (PNS) guided TAP blocks are being frequently given postoperatively for pain these days in laparoscopic cholecystectomy. Aim: To assess the analgesic efficacy of USG guided and PNS guided transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy. Materials and Methods: The randomised clinical study was conducted in the Department of Anaesthesiology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India, from March 2020 to June 2021. Ninety adult patients were enrolled and randomly allocated into three groups. Group 1 (n=30) received bilateral USG-guided TAP block with 20 mL of 0.375% ropivacaine along with standard postoperative analgesia regimen. Group 2 (n=30) received bilateral PNS-guided TAP block with 20 mL 0.375% ropivacaine along with standard postoperative analgesia regimen. Group 3 (Control) (n=30) received standard postoperative analgesia regimen consisting of inj. paracetamol iv 1 gm (6 hourly) and inj. diclofenac 75 mg i.v. (12 hourly). Each patient was assessed for VAS score, duration of analgesia, total analgesic consumption and patient satisfaction for 24 hours postoperatively. Results: The average mean VAS score in first 24 hrs was 2.04±0.80 in group 1, 2.10±0.70 in group 2 and 3.18±0.63 in group 3. The duration of analgesia was least in group 3 (5.8±2.31 hrs) followed by group 2 (9.67±2.47 hrs) and maximum in group 1 (11.87±2.97 hrs). The total tramadol requirement in first 24 hrs postoperatively was 126.67±44.98 mg in group 1, 140±62.15 mg in group 2 and 226.67±63.97 mg in group 3. Conclusion: Postoperative analgesia with USG and PNS guided TAP block enables better pain control and less analgesic consumption. PNS guided TAP block is good alternative when compared with control for postoperative analgesia when USG machine is not available.

AIMAim of our study was to assess effect of 0.5% bupivacaine, 0.5% levobupivacaine and 0.5% ropivacaine in axillary brachial plexus block. OBJECTIVETo compare the onset time and duration of sensory and motor blockade of 0.5% bupivacaine, 0.5% levobupivacaine and 0.5% ropivacaine in axillary brachial plexus. MATERIAL AND METHODNinety patients of ASA I and II of age group 20yrs-60yrs of either sex were included in our study undergoing upper limb surgeries in Gandhi Medical College and Hamidia Hospital, Bhopal (MP). The patients were randomly divided into three groups:-Group I (n= 30) : Bupivacaine 0.5%-5mg/ml-30ml, Group II (n= 30) : Levobupivacaine 0.5%-5mg/ml --30ml, Group III (n=30) : Ropivacaine 0.5%-5mg/ml --30ml onset time of sensory and motor block, duration of sensory and motor block and duration of pain relief were recorded. RESULTAnalysis revealed that Ropivacaine provided fast onset of action and better quality of anaesthesia and analgesia than bupivacaine and levobupivacaine when used in axillary brachial plexus blockade. There was no significant difference in duration of sensory blockade between three groups. But Ropivacaine showed lesser duration of motor blockade when compared to bupivacaine and levobupivacaine. CONCLUSIONWe conclude that 0.5% 30ml of ropivacaine in axillary brachial plexus block is a safe dose, allowing practitioner to produce a fast onset of sensory block and long duration of peripheral nerve block with excellent postoperative analgesia and stable hemodynamics. So ropivacaine is a better option for forearm surgeries in axillary brachial plexus block when compared with bupivacaine and levobupivacaine.

Method: A Prospective observational study of Laparoscopic Repair of Inguinal Hernia by using N-Butyl Cyanoacrylate Glue for mesh fixation without tackers was conducted on 50 patients with Inguinal hernia admitted in Department of General Surgery, M.G.M Medical College and M.Y Hospital Indore (M.P.) during December 2017 to February 2019.Result: There were very few procedure related complications: hematoma formation 2 (4%), wound infection 1 (2%), inguinal hernia recurrence 1 (2%), with significant reduction in postoperative pain and no incidence of chronic pain (beyond 6 months of surgery) Conclusion: This prospective study shows that the use of N-butyl cyanoacrylate glue as an alternative to tacks for mesh fixation in laparoscopic inguinal hernia repair is extremely effective in overcoming the common complication of 'Chronic Inguinal Pain' associated with the use of tacks.