Background: Brachial plexus blockade is a time tested anesthetic technique for upper limb surgeries. Among the various approaches of brachial plexus block, supraclavicular block, once described as the "spinal of the arm," offers dense anesthesia of the brachial plexus for surgical procedures at or distal to the elbow. Landmark technique has been traditionally used for performing this block. But blind technique often requires multiple trial-and-error needle attempts, resulting in increase in procedure time, procedure-related pain and complications including pneumothorax, which is very risky. In developing countries like India, ultrasound is a relatively new technique and is increasingly being used for performing nerve blocks for acute as well as chronic pain procedures. Objective: We performed this study to evaluate safety and clinical usefulness of ultrasound technology for supraclavicular brachial plexus blocks. Methods: We included 60 adult patients of either sex undergoing surgeries for fracture of lower end of humerus or fracture of forearm bones. Patients were divided into two groups. In one group, surface landmark technique was used while in other group, supraclavicular nerve block was performed under ultrasound guidance by double injection technique. All patients received 10 ml each of 2% lignocaine with adrenaline, 10 ml 0.5% bupivacaine and 10 ml of saline. Surgery was started after confirming adequacy of block. Ineffective blocks were replaced with general anesthesia and insufficient pain control during surgery was supplemented with fentanyl. Results: There was no significant difference between patient groups with regard to demographic data. Supraclavicular plexus nerve block was placed in all 60 patients. Block failure was seen in 5 patients in landmark technique group and in one patient in USG group. The time of onset of sensory and motor block was shorter in USG group than landmark technique group. Intra-op analgesic was required in 5/30 patients in blind group and 3/30 patients in USG group. Post-op analgesia was for longer duration in USG guided group as compared to blind group. Conclusion: Ultrasound guidance is clinically very useful for supraclavicular brachial plexus block. It allows visualization of underlying structures, movement of needle and direct spread of local anesthetic and thus making the procedure safer and more effective.

Background: Gabapentin has been used successfully as a non-opioid analgesic adjuvant for postoperative pain management. We hypothesised that gabapentin might be a useful adjuvant for postoperative analgesia in patients undergoing lower extremity surgery under subarachnoid block. Method: Ninety male patients undergoing lower extremity surgery under subarachnoid block were randomly divided into three groups. Group I (n = 30) patients received oral gabapentin 1 200 mg one hour prior to surgery. Group II (n = 30) patients received oral gabapentin 600 mg one hour prior to surgery. Group III (n = 30) patients received an oral placebo one hour prior to surgery. Lumbar puncture was done with 23G Quincke's spinal needle and 2.5 mL of 0.5% heavy bupivacaine was administered intrathecally. Patients were monitored at 0, 1, 3, 5, 8, 12 and 24 hours for assessment of pain and side effects. Patients having pain scores ≥ 5 received rescue analgesia in the form of intravenous tramadol 0.5 mg.kg-1. If the pain score persisted at ≥ 5 after ten minutes, 0.25 mg.kg-1 tramadol was repeated. Results: Pain scores at zero hour were statistically signi cantly lower in patients receiving 1 200 mg of gabapentin (group I) when compared with the other two groups. The total rescue analgesia (tramadol) requirement over the study period was also at the minimum in patients receiving 1 200 mg of gabapentin as compared to patients receiving 600 mg of gabapentin or placebo. However, sedation scores were signi cantly higher in patients receiving gabapentin 1 200 mg or 600 mg than placebo. Conclusion: Preoperative gabapentin, when administered one hour prior to surgery in a dose of 1 200 mg, decreases postoperative pain scores at zero hour and the rescue analgesia requirement signi cantly over a period of 24 hours in patients undergoing lower limb surgery under spinal anaesthesia.

BackgroundWe compared intraocular pressure changes following laryngoscopy and intubation with conventional Macintosh blade and McCoy laryngoscope. MethodsSixty adult patients were randomly assigned to study group or control group. Study group -(Group A, n=30) -McCoy laryngoscope was used for laryngoscopy. Control group (Group B, n=30) -conventional Macintosh laryngoscope was used for laryngoscopy. Pre-medication was given in the form of tablet alprazolam 0.25mg orally at bed time and two hours prior to surgery. Preoperative baseline intraocular pressure was measured with Schiotz tonometer after instillation of 4% xylocaine drops in the right eye. Injection thiopentone sodium 5 mgkg -1 over 20 seconds was used for induction followed by injection vecuronium 0.1mgkg -1 for intubation. All patients were manually ventilated using oxygen 33%, nitrous oxide 67% and halothane 0.5% for three minutes and ETCO 2 was kept below 40mmHg. Laryngoscopy was done as per group protocol. Size 7mm ID cuffed endotracheal tube was used for female patients and size 8mm ID for male patients in both the groups. Intraocular pressure and haemodynamic parameters were recorded just before induction of anaesthesia (baseline), just before laryngoscopy and intubation and 1 and 3 minutes after intubation. ResultsPatient characteristics, baseline haemodynamic parameters and baseline IOP were comparable in the two groups. Following induction (T 0 ), there was statistically significant fall in IOP in both groups. One minute after intubation (T 1 ), there was significant rise in IOP in both the groups and remained so even at three minutes after intubation (T 3 ). When compared in between the groups at one minute after intubation, the rise in intraocular pressure was significantly less in the study group (A). ConclusionWe conclude that McCoy laryngoscope in comparison to Macintosh laryngoscope results in significantly less rise in IOP and clinically less marked increase in haemodynamic response to laryngoscopy and intubation.

Aim: Analysis of ease of insertions, its attempts and time taken to insert for i-gel and cLMA inpaediatric cases. Methods: We did a prospective, randomised single-blind study on Eighty patientsof either sex belonging to American Society of Anaesthesiologists (ASA) physical status class I or II,between 6 months to 8 years of age, scheduled to undergo elective surgery for less than one andhalf hour duration under general anaesthesia. In this study we analysed the ease of insertion,attempts and time were taken to insert the supraglottic airway device. Results: The ease ofinsertion observed was easy in 39(97.5%) in the i-gel group and 35(87.5%) in cLMA group in ourstudy. The i-gel was placed successfully in 39 out of 40 (97.5%) patients in the first attempt, andachieved 100% insertion on the second attempt. Correct positioning of cLMA in the first attempt wasseen in 35 out of 40 (87.5%) patients. The remaining 5 patients (12.5%) required a secondattempt. The average insertion time of cLMA (12.88 ± 1.771 seconds) was longer than the averagetime of insertion of i-gel (9.48 ± 1.037 seconds), and these differences were highly significantstatistically (p= 0.000). Conclusion: To conclude, i-gel and cLMA is effective and safe devices foruse in children. Both are easy to insert and have insignificant morbidity, however, time taken andattempts of insertions for i-gel was lesser than cLMA. Also, the ease of insertion was relatively easyfor i-gel than cLMA in pediatric cases.