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:Prone position is commonly used to provide surgical access to a variety of surgeries. In view of the advantages of induction of anesthesia in the prone position, we conducted a randomized study to evaluate and compare ProSeal laryngeal mask airway (LMA) and i-gel in the prone position.Materials and Methods:Totally, 40 patients of either sex as per American Society of Anesthesiologists physical status I or II, between 16 and 60 years of age, scheduled to undergo surgery in prone position were included in the study. After the patients positioned themselves prone on the operating table, anesthesia was induced by the standard technique. LMA ProSeal was used as an airway conduit in group 1 while i-gel was used in group 2. At the end of surgery, the airway device was removed in the same position.Results:Insertion of airway device was successful in first attempt in 16, and 17 cases in ProSeal laryngeal mask airway (PLMA) and i-gel groups, respectively. A second attempt was required to secure the airway in 4 and 3 patients in PLMA and i-gel groups, respectively. The mean insertion time was 21.8 ± 2.70 s for group 1 and 13.1 ± 2.24 s for group 2, the difference being statistically significant (P < 0.05). The mean seal pressure in group 1 was 36 ± 6.22 cm H2 O and in group 2 was 25.4 ± 3.21 cm H2 O. The difference was statistically significant (P < 0.05). 13 patients in group 1 had fiberoptic bronchoscopy (FOB) grade 1 while it was 6 for group 2. The remaining patients in both groups had FOB grade 2.Conclusion:Insertion of supraglottic airways and conduct of anesthesia with them is feasible in the prone position. The PLMA has a better seal while insertion is easier with i-gel.

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The herbal medications cannot be considered absolutely safe and the unregulated domestic use of herbal medications can have potential life threatening side effects. A 29 year old male presented in emergency department of PGIMS,Rohtak in an intubated status with pancreatitis with MODS. The main etiology was uncertain even till the end. This case report emphasizes on the need of the hour is to educate the common people regarding the safety of herbal medication . Herbal medication can lead to life threatening consequences if taken outside the permissible limits.

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