ABSTRACT:Brachial plexus block is a popular and widely employed regional nerve block of upper extremity which avoids the unwanted effect of anesthetic drugs used during general anesthesia, there complication and the stress of laryngoscopy and tracheal intubation. Patients also have a postoperative period free from nausea, vomiting, cerebral depression and immediate post-operative pain. The brachial plexus via supraclavicular approach block provide safe, effective, low cost complete anesthesia or analgesia of the upper extremity and is carried out at the level of the distal trunks/divisions of the brachial plexus, where it is in its tightest formation thus allowing for rapid and completed anesthesia or analgesia of the upper limb. The present single Centre, prospective, randomized, double blind study was undertaken to compare the effects of Ropivacaine and Ropivacaine-Dexmedetomidine combination in brachial plexus block via supraclavicular route with respect to its onset, duration of action. A total of 60 patients of ASA grading I &II and age ranging 18-50 year of either sex underwent various elective upper limb surgeries were divided in two equal groups Group A (n=30): Received brachial plexus block with 30 ml Ropivacaine (0.75%.) Group B (n=30): Received brachial plexus block with 29 ml Ropivacaine (0.75%) + 1 ml Dexmedetomidine (50µg.) After performing supraclavicular block the following observations were made: 1. Onset of sensory blockade. 2. Duration of sensory blockade. 3. Onset of motor blockade. 4. Duration of motor blockade. 5. Duration of analgesia. The onset and duration of sensory blockade was assessed by pin prick response on area of all four nerves of upper limbs. The onset and duration of motor blockade was assessed by Modified Bromage Scale. The onset and duration of analgesia was assessed by response to pin prick and time of first request of analgesic dose. The observations were as follow: -The average time of onset of sensory blockade was 14.20 ±5.229 mins in-group A and 7.20±2.483 mins in-group B. The observed average onset of motor blockade was 21.00±8.566 mins in group A and 11.83±3.824 mins in group B. The average duration of sensory blockade was 310.37±66.359 mins in group A and 435.87±102.309 mins in group B respectively. The average duration of motor blockade was 278.50 ±66.887 mins in group A and 390.47 ±107.868 mins in group B. The average duration of analgesia was 378.53±80.93 min and 970.83±237.623 mins in groups A and B respectively. There was statistical significant difference in terms of onset & duration of sensory, motor blockade and duration of analgesia between the two groups.

OBJECTIVE: sub arachnoid block is extensively used for the conduction of caesarean section without prophylactic measures; hypotension is a frequent occurrence (in about 80% of the patients). Hypotension is associated with distressing symptoms of dizziness, nausea and vomiting, and may also interfere with the surgical procedure. Present study is a comparison of pre-emptive intramuscular phenylephrine and ephedrine in prevention of spinal anesthesia induced hypotension during caesarian section. METHODS: In this randomized double blind, placebo controlled study, we have evaluated preemptive phenylephrine 2 mg IM; in comparison with ephedrine 45 mg IM and 2 ml saline given just after induction of spinal anesthesia, in terms of hemodynamic stability, development of symptoms like nausea and vomiting and requirement for rescue IV ephedrine vasopressor therapy in patients undergoing lower segment caesarean section. RESULTS: All the groups were comparable with respect to mean age, mean body weight MAP, and mean Pulse rate. In conclusion, pre-emptive use of intramuscular phenylephrine and ephedrine was found to be effective in prevention of spinal anesthesia induced hypotension, nausea and vomiting significantly. However, statistically no difference (p=0.351) was found between the phenylephrine and ephedrine group although the incidence of hypotension, nausea and vomiting was less in phenylephrine group. CONCLUSION: Phenylephrine group seems better to prevent incidence of hypotension, nausea and vomiting among all groups. KEYWORDS: Phenylephrine, ephedrine, MAP, Pulse Rate. INTRODUCTION:Regional anesthesia in the form of epidural or subarachnoid block is extensively used for the conduction of caesarean section and gynecological lower abdominal surgeries. Without prophylactic measures, hypotension is a frequent occurrence (in about 80% of the patients) during spinal anesthesia (Rout CC et al 1993).1 Hypotension is associated with distressing symptoms of dizziness, nausea and vomiting, and may also interfere with the surgical procedure.2 Ideally hypotension should be prevented in patients receiving spinal anesthesia.Prophylactic intravenous hydration has been used as first line measure to prevent hypotension although the place of preloading is now being questioned (Jackson R et al 1995). 2 The management of choice, however, if hypotension occurs is the use of vasopressors as required The usual approach to the use of vasopressors in this clinical setting is reactive rather than proactive; spinal anesthesia induced hypotension is allowed to develop and is then treated accordingly.In this randomized double blind, placebo controlled study, we have evaluated preemptive phenylephrine 2 mg IM; in comparison with ephedrine 45 mg IM and 2 ml saline (IM) given just after induction of spinal anesthesia, in terms of hemodynamic stability, development of symptoms like

BACKGROUND: Addition of clonidine to ropivacaine (0.2%) can potentially enhance analgesia without producing prolonged motor blockade. The aim of the study was to compare the post-operative pain relieving quality of ropivacaine (0.2%) and clonidine mixture to that of plain ropivacaine (0.2%) following caudal block in children's. OBJECTIVE: In this study I examined the quality, post-operative analgesia and haemodynamics effects in children when clonidine is added to ropivacaine for urogenital surgeries in caudal anaesthesia. MATERIAL AND METHODS: In this clinical trial, 30 children's aged 1-10 years who were candidates for elective urogenital surgeries were studied. Induction and maintenance of anaesthesia were achieved using propofol, sevoflurane and nitrous oxide. Children were randomly divided into 2 groups in double blind fashion, and were given caudal block with 0.2% ropivacaine (1ml/kg) alone and ropivacaine plus clonidine 2mcg/kg. Haemodynamic parameters were observed before, during and after the surgical procedure. Postoperative analgesia evaluated using FLACC score and sedation was assessed using Ramsey sedation scale. Paracetamol was given orally for cases with FLACC score 4 or more. RESULTS: Duration of analgesia was found to be significantly longer in the group given ropivacaine plus clonidine. CONCLUSIONS: I concluded that addition of clonidine to ropivacaine prolongs the duration of postoperative analgesia without any respiratory or heamodynamic side-effects.