Supraclavicular blocks in orthopedic patients are considered to be of utmost importance and significance for attaining optimal results. The procedure is considered to obtain muscle relaxation and maintain stable hemodynamics. Moreover, they provide extended post-operative analgesic effects with the least reported adverse effects. The current study observed dexamethasone's effects as an adjuvant therapy along the conventionalanesthetic drugs among orthopedic patients undergoing elbow, forearm and hand surgeries. This study was conducted at the Department of anesthesiology, Aziz Bhatti Shaheed teaching hospital Gujrat, Pakistan, from 1st June 2022 to 30th October 2022. A Sum of sixty (n=60) patients of age group 18-65 years was designated into groups A and B. One group was administered conventional anesthetic drugs, and the other group was administereddexamethasone as adjuvant therapy. Patients were observed for the onset of sensory blockade, motor blockade and duration of the sensory blockade and motor blockade with the help of the Lovett rating scale and sensory score. Findings of the study reported significant differences in the onset and duration of sensory and motor blockade among group B compared to group A. It reported the onset was faster in group B (p<0.05) and longer in duration in group B (p<0.05).Moreover, the visual analog score (VAS) score at 9 hours remained significantly lower among the group receiving adjuvant therapy. No adverse effects were reported among the patients receiving the therapy. The present study suspects the beneficial role of dexamethasone as adjuvant therapy for the group of patients. It concluded that the patients receiving the adjuvant therapy reported faster onset of sensory and motor blockade, which also lasted for longer. Therefore, dexamethasone is reported to have a prolonged anesthetic effect if administered as an adjuvant therapy among orthopedic patients.

Early postoperative pain from laparoscopic cholecystectomy is moderate. A transverses abdominis plane block (TAP) may be an attractive analgesic strategy for reducing postoperative opioid consumption and side effects. The study aimed to assess postoperative mean opioid utilization in patients administered (TAP) block versus placebo undergoing laparoscopic cholecystectomy.This randomized controlled trial was conducted at the Department ofAnesthesiology, Aziz Bhatti Shaheed Teaching Hospital Gujrat,from June 1, 2022, toSeptember 30, 2022. A total of80 patients undergoingLaparoscopic cholecystectomy fulfilling inclusion criteria were recruited and further divided into two equal groups. TAP block procedure was performed in both groups. In group A, 40 patients received 20 mL of isotonic saline 0.9% bilaterallyas a placebo, and in group B, 40 patients had 20 mL of 0.5% bupivacaine. The two groups werecompared for the mean consumption dose of opioid analgesia in 24 hours postoperatively. A T-test was appliedfor statistical differences. (p-Value < 0.05 was taken as significant. Data was collected on specially designed proforma.The total tramadol consumption decreased by 35% in the TAP block group (280.19 ± 56.67mg) compared to the control group (428.79 ± 58.69mg), and the difference was statistically significant (p < 0.001).The mean total pain scores were significantly lower in the TAP block group (46.47 ± 6.17) compared to the control group (60.52 ± 5.67). Thus, it can be concluded from the study that theTAP block is an effective analgesia regimen for reducing postoperative mean opioid requirement and painafter Laparoscopic cholecystectomy.

The purpose of this study was to determine whether or not adding intrathecal tramadol to bupivacaine for lower limb procedures increased the duration of analgesia and decreased the mean post-operative opioid intake. This research was carried out between June 1 and November 30, 2022, in the Department of Anaesthesiology at Aziz Bhatti Shaheed Teaching Hospital in Gujrat, Pakistan. Non-probabilistic sequential sampling was used to pick the patients. One hundred patients from the ASA I, II, and III categories who met the inclusion criteria and were scheduled for lower limb surgery were randomly assigned to one of two groups. The tramadol-bupivacaine group (T) was given 15 milligrams of tramadol and 10 milligrams of bupivacaine (0.5 percent). In comparison, the bupivacaine-alone group (B) was given 1 milliliter of saline and 10 milligrams of bupivacaine (0.5 percent). The duration of analgesia was recorded by tracking the time until the patient first asked for pain medication. The average amount of opioid analgesia taken by both groups in the first 24 hours after surgery was also compared. SPSS version 22 was used for the data analysis. Anesthesia lasted much longer, 174.26 ± 15.21 minutes in the tramadol group, compared to 132.5 ± 14.48 minutes in the bupivacaine group. (p = 0.006). As expected, there was a significant (p 0.001) reduction in 24-hour opioid intake (308.2 ± 23.8) in group T compared to group B (470.5 ±36.2mg). This research confirmed that intrathecal tramadol (15mg) could be safely used with bupivacaine in subarachnoid blocking to increase the duration of analgesia and reduce the need for opioids in the post-operative period following lower limb procedures.

After receiving a spinal anesthetic, shivering is a common side effect. This research aimed to compare the effectiveness of Ketamine and Tramadol in reducing the occurrence of shivering. One hundred and fifty patients aged 18 to 60 with ASA physical status I or II having different surgical procedures were randomly assigned to receive either Intravenous (IV) normal saline (Group P), IV 0.5mg/kg ketamine (Group K), or IV 0.5kg/mg tramadol (Group T).The frequency of shivering, its impact, and the onset of nausea, vomiting, sweating, and nystagmus were all noted. Patients were similar in demographics, body temperature at baseline, operation type, median sensory blockage, surgery duration, and anesthetic. 23.3% of patients (35/150) experienced shivering episodes.Twenty-twopatientsin the placebo group, followed by eight in treatment Group T, and five in treatment group K, reported shivering. The study revealed a statistically significant difference (p = 0.006) between Group K and P. When comparing Group T to Group K (p = 0.871) and Group P (p = 0.724), however, no group showed statistical significance. In group K, nystagmus was one of the most commonly reported adverse effects of IV ketamine, affecting 35 patients (70%). Therefore, compared to the placebo group, Ketamine at a dose of 0.5mg/kg reduces the shivering associated with spinal anesthesia. But there was no statistically significant difference between Ketamine and the intravenous 0.5 mg/kg Tramadolgroup found in our study.