Introduction:To compare the efficacy of combination of epidural local anesthetic with tramadol and butorphanol in major abdominal surgeries.Aims:To evaluate duration of analgesia, analgesic efficacy, and safety profile of two groups of drugs-epidural butorphanol with bupivacaine and epidural tramadol with bupivacaine.Materials and Methods:A prospective, randomized controlled, double-blinded study was undertaken in 50 patients scheduled for major abdominal surgeries. Group B received epidural butorphanol 2 mg + bupivacaine 0.125% first dose and subsequent doses, butorphanol 1 mg + bupivacaine 0.125% (total volume 10 ml). Group T received epidural tramadol 2 mg/kg + bupivacaine 0.125% first dose and subsequent doses, tramadol 1 mg/kg + bupivacaine 0.125% (total volume 10 ml). Observed parameters were the quality of analgesia, sedation, and hemodynamic parameters in the intra and post-operative period. Time for request of rescue analgesia was noted in all the patients. Continuous data are analyzed by Student's t-test using IBM SPSS software version 20. P ≤0.05 was considered to be statistically significant. P ≤ 0.001 was considered to be statistically highly significant.Results:Visual analog scale better with butorphanol group than tramadol (0.12 ± 0.332 and 0.84 ± 0.746 for Group B and Group T) at 30 min after first dose. Onset of action (8.44 ± 1.158 min in Group B and 12.80 ± 1.354 min in Group T) faster with butorphanol but duration of analgesia longer with tramadol (5.92 ± 0.76 h in Group B vs. 7.68 ± 0.76 h in Group T). Sedation was seen in patients with butorphanol group. Nausea and vomiting more frequent with tramadol group.Conclusions:Epidural tramadol with antiemetic is better than butorphanol for its longer duration in ambulatory surgery, elderly patients, obese patients, and suitable high-risk patients.

Tranexamic acid is known as synthetic derivative of lysine. It is an anti-fibrinolytic agent used to treat and prevent major bleeding in the human body. Despite of having similar mechanism of action that of aminocaproic acid this drug is 10x more potent than those traditional aminocaproic acid. Tranexamic acid was first patented in 1957 and that was registered for approval in 1986. The oral formulation of tranexamic acid is used to treat hypermenorrhea – a condition of excessive bleeding during menstruation in women. Injections of TXA are also available to stop bleeding in patients of major accidents. In the recent studies, researchers found that the drug exhibited anti-hyper pigmentary effect in the women who used TXA for their menstruation condition. Later, more studies revealed its mechanism in treatment of hyperpigmentation is promising. If a healthy individual consumes the drug only for the sole purpose of getting flawless skin, it could cause severe side effects like alteration of blood clotting time, high risk of myocardial infraction, varicose vein etc. To overcome these side effects, it was call of time to formulate a topical drug delivery system for Tranexamic acid.

BACKGROUND: Post-operative nausea and vomiting (PONV) affects 30-40% of patients after general anaesthesia.[11] AIMS: To compare the effect of Ondansetron and Dexamethasone for prevention of nausea and vomiting in diagnostic gynaecological laparoscopy. METHODS: Ethical committee approval was taken. Consent was obtained. Patients were divided into 2 groups of 30 each. General anaesthesia was administered to all patients. Inj. Ondansetron 0.15 mg/kg i.v. was given to patients of group O. Injection Dexamethasone 0.2 mg/kg IV was given to patients of group D. Patients were monitored for nausea, vomiting, retching, pain score, side effects and requirement of rescue antiemetic. RESULTS: Inj. Dexamethasone is better than Inj. Ondansetron for prevention of P.O.N.V. in diagnostic gynaecological laparoscopy.

BACKGROUND-Most of the lower abdominal surgeries are performed under spinal anaesthesia which is a popular technique using hyperbaric local anaesthetic solutions such as 0.5% Bupivacaine. The advantages are simplicity of technique, rapid onset of action and reliability in producing uniform sensory and motor blockade. Main disadvantage of using plain local anaesthetic agent arelimited duration of action and lack of longer postoperative analgesia.To overcome this problem, administration of different adjuvant in local anaesthetic is an excellent technique. AIMS-To compare the effect of adding Clonidine and Dexmedetomidine to Bupivacaine for neuraxial block. METHODS-This study was be conducted after the approval of institutional ethical committee. It is a prospective study in which 75 selected patients who were posted for lower abdominal surgeries were randomly allotted into three groups.Group B -Inj.0.5% Heavy Bupivacaine 3.2cc(16 mg) + Inj. Normal saline Group C -Inj.0.5% Heavy Bupivacaine 3.2cc(16 mg) + Inj.Clonidine 30 mcgGroup D -Inj.0.5% Heavy Bupivacaine 3.2cc(16 mg) + Inj.Dexmedetomidine 3 mcg, Total volume injected in all group was 3.5 ml.The end of drug injection was taken as zero time. Onset, duration of sensory blockade, duration of motor blockade was noted. RESULTS –prolonged sensory and motor blockage and superior post-operative analgesia was observed in group D. CONCLUSION- Addition of Dexmeditomidine 3 mcg is significantly more effective than plain 0.5% Bupivacaine or when Clonidine 30mcg was used as adjuvant, for prolongation of sensory and motor blockage and post-operative analgesia.