BACKGROUND The Subclavian Vein (SV) is one of the preferred route for central venous catheterisation. There is limited data comparing the efficacy of Ultrasound (US) guided Supraclavicular (SC) and Infraclavicular (IC) approaches for SV cannulation in India. The purpose of this study was to compare the effectiveness of these procedures. METHODOLOGY We selected 130 patients aged ≥18 years (Mean age 59, men 57%) and recruited them equally into a supraclavicular and infraclavicular groups on alternate basis. Catheterisation was done by a single experienced anaesthesiologist using standard protocols. Information on age, sex, time for locating the vein, puncture time, number of attempts, catheter insertion time and incidence of complications were collected using a structured proforma. Data were analysed comparing the two groups using SPSS. RESULTS The mean time for locating the vein was 24 seconds (s) in the infraclavicular group which is significantly higher than that in the supraclavicular group, 17s (p<0.001). The puncture time was 54 s in the IC group and 40 s in the SC group (p=0.001). Catheterisation time was 132 s in the IC group and 120 s in the SC group (p=0.003). Number of multiple attempts was 22 in the IC group and 8 in the SC group (p=0.005). There were no complications and no guide wire misplacements in either group. CONCLUSION The supraclavicular approach for US-guided subclavian vein catheterisation in adults is clinically more advantageous in terms of shorter time for location, puncture time, catheterisation time, lower number of attempts & a potentially lower incidence of complications when compared to the infraclavicular approach.

OBJECTIVE: Our study aims to evaluate the efficacy of ultrasound guided TAB in postoperative pain relief in a cohort of patients undergoing total abdominal hysterectomy by comparing it with patients who do not receive TAB. The primary end point studied was total 24 hour morphine consumption. The secondary objectives measured were postoperative heart rate, systolic & diastolic blood pressure, respiratory rate, postoperative pain score, nausea, vomiting and sedation score. STUDY DESIGN:Forty patients of ASA I aged 30 to 60 years scheduled for total abdominal hysterectomy surgery in Amala Institute of Medical Sciences, Kerala, India were included in this prospective cohort study. Study duration was for 15 months. First 20 consecutive patients satisfying the inclusion criteria and who received ultrasound guided transverses abdominis block with 15 ml of 0.25% bupivacaine on each side was designated as TAB group. The first 20 patients satisfying inclusion criteria and who did not receive TAB were designated as Non-TAB group. The relevant data of each patient were recorded and the results were statistically analyzed. RESULTS:Patients who received transverses abdominis block with bupivacaine had significantly reduced 24 h morphine requirements in milligrams (TAB group 6.75±2.45, Non-TAB group 12.00±2.51, p value<0.01). The mean time (in hours) to first request for morphine was significantly longer in patients who received transverses abdominis block (TAB group 5.8±2.97, Non-TAB group 1.93±1.17, p value<0.01). There was significant difference in the pain scores at the end of first postoperative hour, with patients without TAB complained of significant pain at rest, cough and movement. At all other time intervals in the first 24hrs the pain scores were higher in the non-TAB group but not significantly different. But pain requiring rescue analgesic (>3) was significantly higher in non-TAB group. CONCLUSIONS:In conclusion we found that ultrasound guided transverses abdominis block provided substantial reduction in morphine consumption when compared with control group. TAB also reduced significantly the time to first dose of rescue morphine. The technique is found to be safe and effective. The study reinforces the recommendation for TAB as a part of multimodal post-operative analgesic regimen.

Background and Aims: Short axis, out of plane (SAOOP) and long axis, in-plane (LAIP) are two approaches employed under ultrasound-guided radial arterial cannulation. Dynamic needle tip positioning (DNTP) is a recently introduced approach which integrates the features of both. Methods: A total of 114 adult patients from American Society of Anaesthesiologists (ASA) I-IV were studied in this hospital-based cross-sectional study after getting Institutional Ethical approval, CTRI registration and prior written informed consent. The primary objective was to compare the success rates among LAIP and DNTP techniques. The radial arterial diameter and its depth were correlated to the success rates in both. Statistical analysis was done using SPSS version 23.0. Results: Success rates were similar in both ( P value-0.094). Ultrasonographic location time (in seconds) was shorter in DNTP (4.351 ± 0.9727) compared to LAIP (7.140 ± 1.0763) ( P value-0.0001). The mean overall diameter and depth of radial artery (in mm) were found to be 2.36 ± 0.02 and 2.51 ± 0.12, respectively. Pearson’s correlation coefficient between cannulation time and diameter was found to be -0.602 ( P value-0.0001) and with depth of the radial artery was 0.034 ( P value 0.723). Conclusion: The success rates were similar in both techniques. Ultrasonographic location time of the radial artery was more in LAIP although cannulation time was similar in both. Cannulation time decreased with an increase in the diameter of radial artery but was unaffected by the depth of the radial artery.