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The aim of the present study is to determine the USG guided popliteal sciatic and adductor canal block for below knee surgeries and postoperative analgesia in high risk patients. Methods: A prospective study was conducted at Bone & Joint hospital an associated hospital of GMC Srinagar, department of Anaesthesiology and critical care medicine, from September 2018 to August 2019. 50 patients with ASA physical status III-IV (diabetes, hypertension, hepatorenal disease, ischemic heart disease), aged 30-70 years were included in this study. Patients allergic to local anaesthetics, on opioids and other analgesics for chronic pain, a refusal for peripheral nerve block and with neurological deficits were excluded from the study. Routine investigations, coagulation profile, renal and hepatic function tests were obtained and 'nil per oral' order was placed six hours prior to the surgery. Analyse the block success rate and sensory and motor block onset time, hemodynamic parameters, duration of post operative analgesia and patient's overall satisfaction. Results: A total of 50 patients with significant co morbidities scheduled for below-knee surgery were included in this study. All patients obtained an adequate sensory and motor blockade and the surgery was performed successfully under ultrasound-guided popliteal sciatic and adductor canal block, with no additional analgesic requirement. The mean duration for sensory and motor block onset time was 3.45±0.52 and 4.77±0.47 minutes respectively. Hemodynamic parameters were maintained stable without gross fluctuation from baseline value throughout the procedure. Average duration of postoperative analgesia as assessed by NRS was ± 0.9 hours. Patient satisfaction as assessed by three-point Lickert's scale was satisfactory, with 80% of patients were graded as per Lickert's scale 1 and 20% of patients were graded as per Lickert's scale 2. Conclusion: Ultrasound-guided combined popliteal sciatic and adductor canal block is an effective alternative anaesthetic technique for below-knee surgeries with better stability of hemodynamic parameters and pain management in high-risk patients.

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.