Objective: To compare the mean pain score with inguinal block under general anesthesia versus subarachnoid block in adult patients undergoing inguinal hernioplasty. Design of the Study: Randomized controlled trial Study Settings: This cross-sectional study was conducted at Department of Anesthesiology, Sir Ganga Ram Hospital, Lahore from January 2021 to June 2021. Materials and Methods: Sample of 200 cases was included through non probability purposive sampling. In group A, patients were given inguinal block and in group B, patients were given subarachnoid block. In Inguinal block group, a 10mL of Bupivacaine (0.5%) will be given at junction of 2/3 form umbilicus and 1/3 from anterior superior iliac spine after administration of general anesthesia with laryngeal mask airway. Patients were followed at 1, 2 and finally on 4 hours after surgery for measurement of pain. Results: The mean age of 39.63±6.50 years. Out of total 200 patients, 186 (93%) were males and 14 (7%) were females. The mean pain score at 1st hour in inguinal group was 0.76±0.87 whereas pain score in Subarachnoid block was 1.18±0.92. Similarly after 2nd hour inguinal group pain score was 0.88±0.84 and with Subarachnoid block was 1.33±1.04. At 3rd hour, with inguinal block mean pain score was 1.02±0.92 and with Subarachnoid block was 1.80±1.20. At 4th hour, with inguinal block mean pain score was 1.59±1.07 and with Subarachnoid block was 3.09±1.60. Statistically there is highly significant difference of mean pain score between both groups i.e. p-value<0.05. There was drastic increase in mean main score at 4th hour with subarachnoid block as compared to inguinal block showing that inguinal block is more effective in reducing pain after 4 hours of surgery. Conclusion: It was concluded from results of this study that inguinal block is more beneficial in controlling pain after inguinal hernia surgery as compared to subarachnoid block Keywords: Inguinal Hernia, Inguinal block, Spinal anesthesia, General anesthesia

Objective: To determine the positive predictive value of upper lip bite test in predicting difficult intubation by taking Cormack and Lehane classification as gold standard. Design of the Study: Cross sectional study. Study Settings: This cross-sectional study was conducted at Department of Anesthesiology, Sir Ganga Ram Hospital, Lahore from 04/06/2021 to 03/12/2021. Materials and Methods: This study involved 313 patients of both genders, aged between 18-70 years undergoing general anesthesia on elective lists having positive upper lip bite test (Grade-III). On the basis of Cormack and Lehane Classification, the diagnosis was verified. Results of the ULBT were compared to the Cormack and Lehane grade-III and grade-IV diagnoses. Every patient's written informed permission was obtained. Results: In The mean age of the patients was 43.78±12.32 years. Majority (n=150, 47.9%) of the patients were aged between 36-52 years. There were 198 (63.3%) male and 115 (36.7%) female patients in the study group. Among the procedures, herniorrhaphy (32.9%) and cholecystectomy (26.8%) were the more frequent procedures followed by thyroidectomy (17.6%), tonsillectomy (13.1%) and mastectomy (9.6%). Majority (42.8%) of the patients belonged to ASA Class-I followed by ASA Class-II (29.7%) and ASA Class-III (27.5%). Difficult intubation was confirmed in 232 (74.1%) patients on Cormack and Lehane Classification (as per operational definition). Thus there were 232 true positive patients with 81 false positive patients. With the gold standard Cormack and Lehane Classification, the upper lip bite test yielded a positive predictive value of 74.1 percent in the prediction of difficult intubation. Conclusion: According to the gold standard of Cormack and Lehane Classification, an upper lip bite test (Grade-III) has a 74.1 percent positive predictive value for difficult intubation in patients undergoing general anaesthesia with endotracheal intubation on the elective list. Keywords: Difficult Intubation, Cormack and Lehane Classification, Upper Lip Bite Test