Background: Organophosphate (OP) pesticides are the main agents for pest control in agricultural crops making them the agent of choice for self-poisoning. In India, self-poisoning with OP pesticides is the second most frequently reported method of suicide owing to its ready and easy availability with mortality varying from 12% to 50%. Methods: A retrospective study was conducted over a period of one year to compare the socio-demographic variables with the outcomes in patients with OP poisoning. A total 94 patients were consecutively included in the study and a statistical analysis was carried out. Results: Majority of the patients belonged to the 21-30 years age group (54.3%), emphasizing the involvement of the young and productive age group into suicidal attempts. The study population consisted of 58 males (61.7 %) and 36 females (38.3%) depicting a higher incidence of OP poisoning amongst males. There was an overall mortality of 3.2 % amongst the treated patients. Females had a higher mortality (5.6%) as compared to males (1.7%). It was observed that the mortality was the maximum among the 41-50 years age group patients (p = 0.007). Conclusions: Self-poisoning with OP pesticides is highly prevalent in the rural areas due to the ease of availability of these compounds and lack of regulatory control over the same. The young population is the most commonly affected by this. Regulation in sales and distribution of pesticides should be taken as a priority and early treatment yields a favourable outcome in majority of the patients.

INTRODUCTIONA lower segment caesarean section (LSCS) commonly induces moderate to severe postoperative pain for 48 hours.1 Care for the newborn, breastfeeding and mobilisation require the mother to be pain-free in the postoperative period. It has been noted that acute pain during childbirth is responsible for postpartum depression and post-traumatic stress disorder in mothers.2 This calls for a need to develop adequate pain relief methods in post LSCS patients, keeping in mind lactating mothers and the health of their newborns.The major trend in the provision of anaesthesia services to pregnant women over the past 25 years has been the increasing use of regional anaesthetic techniques for labour and operative delivery.3 A report on confidential enquiries into maternal deaths in the United Kingdom states that, at least 80% of caesarean deliveries are now performed under regional block. 4 ABSTRACT Background: A lower segment caesarean section (LSCS) commonly induces moderate to severe postoperative pain for 48 hours. Aim of the study was to compare 0.25% bupivacaine with dexamethasone and 0.25% bupivacaine with clonidine for transversus abdominis plane (TAP) block as post-operative analgesia in patients undergoing lower segment caesarean section (LSCS). Methods: A randomized prospective controlled clinical study was conducted in 104 patients undergoing LSCS. Participants were divided into two groups in which group TAP-D (n=54) received 0.25% Bupivacaine with Dexamethasone 4mg and those in group TAP-C (n=50) received 0.25% Bupivacaine with Clonidine 75mcg as TAP block at the end of surgery. The postoperative pain was evaluated by visual analog scale (VAS) for pain scoring at every 2 hours for 12 hours postoperatively. Subjective assessment of duration of analgesia was done. Results: The average duration of analgesia with TAP bock for the overall study population was 316.15 minutes. The average VAS score in patients who received TAP with dexamethasone was 1.50 which is significantly lower than those who received clonidine (1.95) (P value-0.0001). Further the duration of analgesia was 151 minutes longer in the first group who received dexamethasone TAP. In majority of the patients (84%) who received clonidine TAP, the analgesia persisted for 2-4 hours. While in patients who received dexamethasone addition, the analgesia persisted for 6-8 hours in 37%. Conclusions: TAP block is a safe and effective way of relieving postoperative pain in LSCS patients. Addition of dexamethasone to bupivacaine significantly enhances its effect in terms of block quality and analgesia duration as compared to clonidine addition.