Background: Caesarean section being a major surgical procedure is associated with substantial postoperative discomfort and moderate to severe pain for 48 hours postoperatively. This prospective study was undertaken to observe the ultrasound guided quadratus lumborum block and transversus abdominis plane block for postoperative analgesia after lower segment caesarean section under spinal anesthesia. Materials and Methods: Hundred patients belonging to ASA class I & II and a normal singleton pregnancy with a gestation of at least 37 weeks posted for elective caesarean delivery under spinal anesthesia were selected. The patients who had received either TAP block or QL block were assigned two groups. The patients who had received TAP block were assigned group A and the patients who had received QL block were assigned group B. Results: The overall VAS score in group B was lower than in group A. The duration of analgesia in Group A ranged from 6-12 hours with a mean duration of 8.5±1.998 hours. In Group B the duration ranged from 9-24 hours with a mean duration of 16.5±3.096 hours. The difference in duration of analgesia between the two groups was statistically significant. In group A the mean analgesic consumption dose was 1.07±0.264 grams at 12 hours, 2.11±0.317 grams at 24 hours and 2.67±0.673 at 48 hours. In group B it was 0.43±0.501 grams at 12 hours, 1.35±0.567 grams at 24 hours and 1.65±0.604 grams at 48 hours. The difference was statistically significant Conclusion: It can be concluded that Ultrasound Guided nerve blocks (TAP block and QL block) can be used as a part of multimodal analgesia for better postoperative pain relief in lower abdominal surgeries like LSCS especially when given before the resolution of spinal anaesthesia. Further it was observed that QLB was superior to TAP block in terms of better pain control (duration and quality) as shown by lower VAS score, demand for the first rescue analgesia which was delayed and total consumption of rescue analgesia was less in the first 48 hours.

The aim of this study is to determine the incidence and magnitude of hemodynamic changes after subarachnoid block in patients with pre-eclampsia undergoing caesarean section. Methods: A prospective observational study was conducted at LD Hospital SMHS GMC Srina gar, India, to determine the incidence of hypotension and the magnitude of hemodynamic changes following spinal anesthesia in pre-eclampsia and non-preeclampsia parturient who underwent caesarean section, from September 2018 to August 2019. 50 participants were enrolled in the preeclampsia group and 50 participants were enrolled in non-preeclampsia groups with a proportion of 1:1 ratios respectively. In the operation theatre, baseline hemodynamic variables (SBP, DBP, MAP, and HR) were recorded. The total intraoperative fluid consumption, total estimated blood loss, the weight of the new born were documented as well. Results: A total of 100 parturient were enrolled (50 non-preeclampsia and 50 pre-eclampsia parturient) in this study. The mean gestational age at the time of Caesarean section was significantly lower in the pre-eclampsia group: 38.36±1.53 weeks in non-preeclampsia versus 37.84±1.35 weeks in pre-ecliptics, p = 0.001 (Table 1). However, there was no statistically significant difference in the mean weight of the new born between groups; p = 0.37. The median upper sensory level at the time of skin incision was higher in the pre-eclampsia parturient compared to those with non-preeclampsia and this difference was statistically significant (T5 vs. T6; p = 0.029). Non-preeclampsia parturient received a higher volume of preload fluid compared with pre-ecliptics (613.99 ± 276.69 ml VS 559.76±322.78 ml; p = 0.003) and there was a statistically significant difference in intraoperative intravenous fluid consumption between groups, which was higher in non-preeclampsia compared to pre-eclampsia parturient (1718.87±345.79 vs 1487.63±421.77; p = 0.001). Conclusion:The incidence and magnitude of spinal anesthesia induced hypotension in parturient who underwent caesarean section were less in pre-ecliptics than in non-preeclampsia parturient.

The aim of the present study to compare the effects of Dexmedetomidine and fentanyl as adjuvants to hyperbaric bupivacaine in elective ceasearen sections. Methods: This prospective study was done in the Department of anaesthesiology, LD hospital an associated hospital of GMC, Srinagar, India from December 2019 to November 2020. The participants included 130 parturient with gestational age ≥37 weeks and ASA I and II candidates for elective caesarean section under spinal anesthesia were included in this study. All 130 patients were randomly and equally divided into the following two groups: Group B-D received 10 mg hyperbaric bupivacaine 0.5%+10 μg dexmedetomidine. Group B-F received 10 mg hyperbaric bupivacaine 0.5%+25 μg fentanyl. Hemodynamic monitoring including SBP and DBP, mean arterial pressure (MAP), heart rate (HR) and peripheral oxygen saturation level (SpO2) were recorded. Patient's pain score was assessed using visual analogue scale (VAS); scored from 0-10 (where 0=no pain and 10=the worst pain imaginable) during the recovery room (T0) and at one, three, and six hours (T1, T3, and T6) in the postoperative period. If the VAS score was more than 3, a rescue dose of tramadol (100 mg) was administered intravenously. Results: The mean dose of mephentermine in the B-D and B-F groups were 5.45±6.74 and 6.79±5.69mg, respectively. The Mann-Whitney test showed that there was no significant difference between the two groups (P=0.78). With respect to the bradycardia, the mean dose of atropine in the B-D and B-F groups were 0.12±0.28 and 0.06±0.15 mg, respectively. According to the Mann-Whitney test, in this regard, no significant difference was seen between the two groups. (P=0.32). The results of the Mann-Whitney U-test indicated that the onset of block in the B-D group (97.88±32.78 seconds) was significantly faster than in the B-F group (112.03±36.68 seconds) (P=0.041). Considering the level of sensory block, T4 level was shown in 81 (62.31%) patients, from whom 47 (58.02%) and 34 (41.98%) patients were in the B-D and B-F groups, respectively. Moreover, T6 level was observed in 49 (37.69%) patients, from whom 19 (38.78%) and 30 (61.22%) patients were in the B-D and B-F groups, respectively. Chi-squared test revealed that there was no statistically significant difference between the two groups (P=0.13). Conclusion:Compared with fentanyl, it seems that adding 10μg dexmedetomidine to bupivacaine has a better effect on postoperative pain management in cesarean section under spinal anesthesia.

Background: In the first half of 2020 COVID-19 disease has already converted into a global pandemic. Various treatment options were being tried all over the world. The ROX index (Respiratory rate – Oxygenation), defined as the ratio of peripheral oxygen saturation and fraction of inspired oxygen, to respiratory rate, is a simple bedside test to predict failure of HFNO Therapy and need for MV. Aim: The aim of the study was to evaluate the accuracy of the ROX index for Predicting the failure of HFNO Therapy and need for Intubation in Patients of COVID-19 Pneumoniawith type I respiratory failure. Methods: An observational study of consecutive patients admitted in ICU of the department of Anesthesiology, critical care and pain management in Govt. Medical college Srinagar (J&K) over the period of six months with moderate tosevere type I respiratory failure treated with High Flow Nasal OxygenTherapy (HFNOT). One hundred and thirty four RT-PCR positive COVID-19 patients were enrolled. The following data were collected: medical history, clinical classification of COVID-19 infection, the ROX index measured daily and the outcome assessment. Results: We performed this observational study on 134RT-PCR positive COVID-19 patients. 70 (52.23%) patients with moderate to severe COVID-19 infection were intubated, 60% of them third day of admission, only 35% patients with moderate COVID-19 infection required intubation. Presence of comorbidities was directly associated with ROX index. At intubation, median (min-max) of ROX and PO2/FiO2 ratio was 4.02 (2.99–5.10) and 88.10 (58–106.15), respectively. ROX 1, 2, 3 indices were significantly as¬sociated with intubation (p < 0.001 for each of them). COVID-19 clinical classification was sig¬nificantly associated with intubation (p < 0.001). Conclusion: ROX index is a valuable, noninvasive tool to evaluate patients with moderate to severehypoxemic respiratory failure in COVID-19 treated with HFNOT. ROX is a simple noninvasive promising ......