ABSTRACT:In the present day practice of Anesthesiology, bupivacaine is the most commonly used drug for spinal anesthesia. To improve upon the quality of analgesia and prolong the duration of its action, many adjuvants have been tried. Intrathecal clonidine an α2 adrenceptor agonist has potent central antinoceptive properties with analgesic effect at spinal level mediated by postsynaptically situated adrenoreceptor in dorsal horn of spinal cord. Low doses of clonidine have shown effectiveness in intensifying spinal anesthesia. Hence this study was done in our institute to evaluate the efficacy of spinal anesthesia with clonidine added to hyperbaric bupivacaine in elective lower limb, lower abdominal, gynaecological and urological surgeries under spinal anaesthesia. This prospective, single center parallel group, double blind study conducted over a span of 1 year with 100 patients, was effective in proving that Clonidine potentiates bupivacaine spinal anesthesia by increasing the duration and improving the quality of analgesia without producing significant hemodynamic side effects and with mild sedation. KEYWORDS: Alpha 2 agonist, 0.5% Bupivacaine, Clonidine as adjuvant, Effective analgesia. INTRODUCTION:Spinal anesthesia, defined as the regional anesthesia obtained by blocking nerves in the subarachnoid space is a popular and common technique used worldwide. The advantages of an awake patient, simple to perform, offers rapid onset of action, minimal drug cost, relatively less side effects and rapid patient turnover has made this the choice of many a surgical procedure. 1 These advantages are sometimes offset by relatively short duration of action and uncomfortable postoperative period when its action wears off. In order to extend intraoperative analgesia into postoperative period a number of spinal adjuvants like opioids, clonidine, ketamine, morphine and buprenorphine and so on have been added to prolong intrathecal bupivacaine action.Recently clonidine which is an α2 adrenergic agonist has been tried as an adjuvant to prolong the action of local anesthetics. Intrathecal clonidine produces dose dependent analgesia and has been successfully used as a sole analgesic via the intrathecalroute. 2 hence, this study was designed to evaluate the effectiveness of adding30μg clonidine to bupivacaine for spinal anesthesia and to compare its use with that of bupivacaine.

Background: Meningiomas are one of the most common primary intracranial tumours. The incidence, varieties of tumour, site, imaging findings, resectability, outcome and prognosis vary from tumour to tumour. The understanding of these characteristics is essential in the management of meningiomas.Methods: An observational study was carried out among 50 patients with imaging proven meningioma and involved recording of age, gender, clinical history, physical examination, imaging findings, intraoperative characteristics, anatomical and pathological diagnosis. The parameters evaluated in the study were gender distribution, age distribution, presenting symptoms, neurological deficits, mri findings, volume of tumour, intraoperative findings, grade of excision, anatomical, pathological diagnosis and recurrence rates.Results: The male to female ratio was 1:2.57, with 50-70 years being the most affected population. The common symptomatology was that of features of raised ICP with motor deficit as the common neurological abnormality. Simpson grade 2 was the common clearance obtained. 3 common sites were parasagittal, sphenoid wing and convexity. Commonest histological type was transitional. Recurrence rate was 6%. This study also pointed out general imaging and intraoperative characteristics of Grade 3 tumours as T2 hyperintensity, heterogeneous, with significant perilesional oedema and intensely contrast enhancing, high vascularity, friable, suckable and ill-defined margins.Conclusions: The study enables us to understand the general trend of presentation, imaging and surgical properties of Meningiomas and to compare with international standards. It also helps us to finger out the possible high-grade lesions even before the pathological diagnosis is obtained.