Background Intrathecal anesthesia is common for parturients undergoing lower-segment caesarean section. Various adjuvants are added to intrathecal bupivacaine for potentiating pharmacological effects, improving quality of sensorimotor block and postoperative analgesia, and preventing adverse effects. The study period was from November 2017 to September 2018, and it was a randomized double-blinded observational study. The sample size calculation was done according to results of our pilot study (done with 5 patients in each group) and discussion with the institutional review board. Also, in this study, we aim to assess nalbuphine/midazolam as adjuvant to intrathecal bupivacaine for LSCS in terms of quality of sensorimotor block, postoperative analgesia, adverse effects, hemodynamic stability, and Apgar scores of baby at 1 and 5 min. One hundred full-term parturients between 20 and 35 years of ASA grade I/II scheduled for elective lower-segment caesarean section after approval from the institutional review board, and written informed consent were allocated into 2 groups. Randomization was done at the time of giving intrathecal anesthesia by odd and even numbers in an opaque sealed envelope. Group A (n = 50): Bupivacaine heavy (0.5%) 2.0 ml (10 mg) + 0.2 ml Preservative-free inj. midazolam 1 mg Group B (n = 50): Bupivacaine heavy (0.5 %) 2.0 ml (10 mg) + 0.2 ml (0.75 mg) Preservative-free inj. nalbuphine The primary outcome was to assess the perioperative hemodynamic stability, Apgar score, and postoperative analgesia, and the secondary outcome was to assess the complications and adverse effects during the study period. Results The onset of sensory and motor block was earlier in group A than in group B. Total duration of effective postoperative analgesia was more in the midazolam group as compared with the nalbuphine group. The incidence of complications (nausea, vomiting, and pruritus) were more in group B as compared with group A. Conclusion Nalbuphine and midazolam both are good adjuvants to hyperbaric bupivacaine for LSCS in terms of hemodynamic stability and good Apgar scores at 1 and 5 min. Intrathecal midazolam provides better postoperative analgesia and less adverse effects.

BACKGROUND The purpose of the present study was to evaluate the efficacy of intravenous lignocaine 1.5 mg / kg & intravenous dexmedetomidine 1 mcg / kg for attenuating the haemodynamic response to laryngoscopy & endotracheal intubation in patients undergoing elective surgery under general anaesthesia. METHODS In this prospective randomised, comparative, clinical study, 60 patients were randomly divided into 2 groups, among them 30 patients were given infusion of 1.5 mg / kg IV lignocaine, diluted to 10 ml with normal saline, 3 minutes before intubation & 30 patients were given infusion of dexmedetomidine 1 mcg / kg diluted to 25 ml in normal saline over 10 minutes through infusion pump before induction. The heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, rate pressure product, oxygen saturation were measured at baseline, after study drug intubation at L + 1, L + 3, L + 5, L + 7 & L + 10 (L is onset of laryngoscopy). Statistical analysis was done by using descriptive & inferential statistics using chisquare test, Students paired & unpaired t test to find out the significance of the five variables namely mean heart rate (HR), mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), mean arterial pressure (MAP) and mean rate pressure product (RPP). RESULTS Dexmedetomidine provided better blunting of stress response during laryngoscopy and intubation without causing clinically significant respiratory depression, bradycardia or hypotension. It is better in achieving a low RPP, which is a good predictor of myocardial oxygen consumption. Dexmedetomidine provides better cardio-protection in patients against pressure response than lignocaine. CONCLUSIONS In these 60 patients, dexmedetomidine (1 mcg / kg) was found to be superior to lignocaine (1.5 mg / kg) for attenuation of pressor response. KEY WORDS Laryngoscopy, Endotracheal Intubation, Dexmedetomidine, Lignocaine, Rate Pressure Product

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Background: Ankle& foot surgeries are very common surgeries in various age groups like young & geriatric as well as in patients with comorbidities.popliteal nerve block is one of multimodal Anaesthesia & analgesia for same.we have used ultrasound guided block to prevent complications &precise volume at asite for improving Charisteristics of block. Aims of study: To study the technique of giving popliteal nerve blocks with ultrasonographic guidance and evaluate it in terms of: No of attempts ,Time required for sensory and motor blockade,Quality of Intra operative analgesia ,Duration for post operative analgesia , Supplementation required in form of general anaesthesia & Complications encountered. Methods: We have given ultrasonography guided popliteal nerve block in 100 adult patients of ASA grade I/II/III undergoing foot and ankle surgeries. The volume of drug used was 20ml consisting of Lignocaine(1.5%) 10ml and Bupivacaine(0.5%) 10ml+ 2 ml Normal saline in Group A& addition of dexamethasone 8 mg as adjuvant to LA in Group B. Results: The mean time taken to conduct the block was 4.3±1.4 mins in Group A,4.2±1.6 min inGr.B.The mean time taken for sensory onset was 3.8±1.1 mins in Gr A,3.6±1.4min in Gr.B .The mean time taken for motor onset was 7.2± 1.4 mins in GrA,7.0± 1.5 mins in Gr B.The mean time taken for completing the surgery was 39.2±5.0 mins in GrA,38.2±5.2 mins in Gr.B.The mean time taken for complete motor regression was 143.8±13.5 mins in Gr A,340.8±10.5 mins in Gr B.The mean time taken for complete sensory regression was 184.8± 16.8 minsin Gr.A,379.8± 18.8 mins in Gr B.(p<0.05)The patients first complained of pain at the mean time of 239±22.4 minsin Gr A,1069±12.4 minsin Gr B( p<0.001) In both groups,patients have stable haemodynamic parameters throughout the operation.supplementation of sedoanalgesia was given in 4 patients in the form of Injection Midazolam 1mg IV and Injection Fentanyl 50 microgm IV was given in 2 patients and general anaesthesia was given in 2 patients in both groups.No other neurological complications were noticed in our study. Conclusion: ultrasound guided Popliteal nerve block is safe& effective block for various ankle &foot surgeries. Dexamethasone is effective adjuvant in popliteal sciatic block for foot& ankle surgeries as it increase time to analgesic request.

Introduction: Postoperative analgesia is very important parameter for overall management of pediatric patients. Aims: To compare the analgesic efficacy of caudal dexmedetomidine versus caudal tramadol with bupivacaine 0.25 % in paediatric Infra-umbilical surgeries. Objectives: To study hemodynamic changes. The duration of post-operative analgesia and to compare motor block and post-operative sedation in both groups, as well as the side effects associated with analgesia in both the groups. Methods: The study was carried out in 60 patients of either sex belonging to ASA Grade-I/II between age group of 1 to 8 years undergoing infra umbilical surgeries. After taking written informed consent from all the patient's care taker, pre-anaesthetic evaluation was carried out and procedure was explained to patient's care taker. Patients were randomly devided into 2 groups. Group BT: Patient received 1 ml/kg 0.25% bupivacaine with tram-adol 1 mg/kg. Group BD: Patient received 1 ml/kg 0.25% bupivacaine with dexmedetomidine 1 µg/kg. Our method of anaesthesia was G. A. with caudal block. Postoperative analgesia was assessed by FLACC score for 24 hours and If FLACC ≥ 4, Paracetamol suppository (15 mg/kg) was given as rescue analgesia. Post-operative sedation was assessed by Ramsay sedation score up to 6 hr postoperatively. Postoperatively, all the patients were monitored for any complications like Nausea, Vomiting, Shivering, Bradaycardia, Hy-potension and Respiratory depression. Results: Patients were comparable in both the groups regarding age, weight, sex distribution (P > 0.05). Mean duration of surgery in group BT was 55.3 ± 9.6 mins, in group BD was 56.7 ±12.8 mins. There was no statistically significant difference in the duration of surgery between the two groups on intergroup comparison (p > 0.05). There was no statistically significant difference in mean heart rate, mean arterial pressure and mean oxygen saturation between the groups on intergroup comparison intraoperatively and postoperatively (p > 0.05). Ramsay Sedation score was 2.0 ± 0.4 at 1 hr posto-operatively in Group BT patients. So, after 1 hr of surgery, patients of BT group remained anxious, restless and agitated. While in group BD, Sedation score was 2.0 ± 0.3 at 6 hr postoperatively. Thus all patients remained cooperative , oriented and tranquil up to 6 hr post-operatively. Group BD had significant sedation compared to Group BT for 6 hrs postoperatively (p < 0.05). We observed significant difference between the groups in terms of FLACC score. Group BT patients achieved statistically significantly higher FLACC score compared with Group BD.(P < 0.05). The mean duration of analgesia was 6.9 ± 1.2 hr in Group BT, 13.2 ± 2.8 hr in Group RD (p < 0.05). There was a statistically significant prolongation in the duration of analgesia in Group BD (p < 0.05). In present study, incidence of nausea and vomiting occurred in 5 (16.7%) of patients in Group BT and 3 (6.7%) in Group BD. None of the patients had Shivering, Brady-cardia, Hypotension, Respiratory depression, Neurological sequale in both the groups.