Laparoscopic cholecystectomy (LC) is a commonly performed minimally invasive surgery. LC can cause moderate to severe postoperative pain due to small keyhole entries on the abdominal wall. The oblique subcostal transversus abdominis plane block (OSTAP) has been used for postoperative analgesia after LC but found not so effective. Our aim is to compare the effectiveness of erector spinae block with OSTAP block for postop analgesia after LC. Materials and Methods: This prospective, randomized study was conducted at a tertiary care hospital. Seventy patients, 18 to 65 years old posted for LC were divided into two equal groups of 35 each. Erector spinae plane block was performed in the ESP group and oblique subcostal transverses abdominis plane block was performed in the OSTAP group. Postoperative rescue analgesic consumption, time to 1 st rescue analgesia, numerical rating score (NRS), and any complications in 1 st 24 hrs between the groups were compared. Results: Postoperative rescue analgesic (paracetamol) consumption was 1.9± 0.85gm in ESP group and 2.84 ± 0.29gm in OSTAP group which was statistically significant. Time to 1 st rescue analgesia request was 360.34±28.94 mins in ESP group and 280.51±45.66 mins in OSTAP group which was statistically significant. Although NRS scores at almost all time-points were lower in the ESP group compared to OSTAP block, the difference was significant in 1 st 6 hrs. Conclusion: Ultrasound guided ESP block reduced postoperative rescue analgesic consumption and pain scores more effectively than OSTAP block after laparoscopic cholecystectomy surgery.

Introduction Interscalene block (ISB) is commonly used for efficient pain relief after arthroscopic shoulder surgery. But, it is linked with a greater occurrence of unilateral diaphragmatic paralysis (UDP). This may add to patient dissatisfaction and also may not be tolerated well by patients having respiratory diseases. We have compared the efficacy of costoclavicular block (CCB) with ISB for postoperative analgesia in patients undergoing arthroscopic shoulder surgery. Materials and Methods Fifty patients were divided into two groups of 25 each (ISB or CCB group). In total, 20 mL of 0.5% levobupivacaine along with 4 mg of dexamethasone as adjuvant was used during both ultrasound-guided ISB and CCB. Numerical rating scale (NRS) scores for pain were assessed at 0, 0.5, 1, 2, 3, 6, 12, and 24 hours in postoperative period. The mean onset time of block, time of first painkiller demand, total painkiller demand for 24 hours postoperatively, patient wellbeing, incidence of UDP, and any other complications were recorded. Results NRS pain scores in both groups at 0, 0.5, 1, 2, 3, 6, 12, and 24 hours were comparable. (p > 0.05) Mean onset time of block was earlier in ISB group contrary to CCB group (p < 0.05). There was higher occurrence of UDP in ISB group contrary to CCB group (p < 0.05). There was no notable variation regarding the time of first painkiller demand and total painkiller demand in the first 24 hours. Patients were more satisfied in CCB group contrary to ISB group. Conclusion As CCB provided equivalent analgesia in postoperative period like ISB without any risk of UDP, it can be a better substitute to ISB for pain relief in arthroscopic shoulder surgery.

Background: A lot of researches have been done to find an ideal adjuvant to bupivacaine in epidural anaesthesia that inhibits intra and post operative pain and prolongs the duration of anaesthesia without any side effects. Study regarding antinociceptive effect of magnesium in epidural route is very limited. Aim: This study was done to evaluate the onset, extent and duration of sensory and motor block and side effects of clonidine and magnesium sulfate when used as an adjuvant to bupivacaine in epidural anaesthesia in lower limb orthopedic surgery. Methods: A prospective randomized double blind study was conducted on 60 patients of American society of anaesthesiologists status I and II, posted for lower limb orthopedic surgery. All patients were randomly allocated into two groups of 30 each; group I was bupivacaineclonidine group (BC) and group II was bupivacaine -magnesium sulfate group (BM). Group I (BC) patients received 16 ml of 0.5% bupivacaine and clonidine 2mcg/kg. Group II (BM) patients received 16 ml of 0.5% bupivacaine and magnesium sulfate (50 mg). The onset, extent, duration of sensory and motor blocks and side effects were recorded. Results: Magnesium sulfate had a visible edge over clonidine as it enabled an earlier onset of sensory block but duration of analgesia was more in clonidine group. Sedation scores were statistically significant with BC group in comparison to BM group. Both groups were haemodynamically stable in peri and post-operative period. Conclusion: Magnesium sulfate was a better alternative to clonidine as an adjuvant to bupivacaine in epidural anaesthesia in orthopedic lower limb surgeries for rapid onset of action but clonidine has prolonged duration of action.