BACKGROUND:The prime duty of any anesthesiologist is to relive pain in the perioperative period. Today regional anesthesia is well established as equal to general anesthesia in effectiveness and patient acceptability. Regional anesthesia is blocking of peripheral nerve conduction in a reversible way using local anesthetic agents. For surgeries on upper extremities, particularly in emergency surgeries, regional anesthesia has many advantages over general anesthesia. The brachial plexus is approached at the level of trunks and the compact arrangement of trunks at the supraclavicular level gives a high success rate with minimum local anesthetic drug volume and a dense and fast onset of the block. To prolong the duration of analgesia various drugs have been studied as adjuvants to the local anesthetics. This study is intended to determine the effects of adding Clonidine to Bupivacaine in brachial plexus blockade by Nerve locator assisted supraclavicular approach, with regard to the onset, intensity and duration of blockade along with its analgesic efficacy. METHODS: Forty adult patients of both sexes in the age group of 20-60 years of weight ranging from 50-70kg belonging to ASA I/II category posted for various types of upper limb surgeries the patients were randomly allocated into two groups,. Supraclavicular brachial plexus block was performed via peripheral nerve locator assisted subclavian perivascular technique. Group -B (Bupivacaine alone)-20 patients received 30ml of 0.375%Bupivacaine with 2ml of 0.9% sodium chloride solution. Group-BC (Bupivacaine+Clonidine)-20 patients received 30ml of 0.375%Bupivacaine with Clonidine hydrochloride 100μg (1ml of 150μg diluted with 2ml 0.9% NaCl solution. From that 2ml used for study. (The following parameters are assessed Onset of blockade, Duration of blockade, Intensity of blockade, Sedation, Quality of analgesia, Haemodynamic changes & Complications if any RESULTS: Onset time for both motor and sensory block was quicker in the Bupivacaine with clonidine group, Time taken for completion of both motor and sensory blockade was, significantly lesser in clonidine group, There was no difference between the groups in the intensity of blockade., The mean duration of both sensory & motor blockade was significantly prolonged in clonidine group, Sedation was statistically significant with Bupivacaine-clonidine group in the intraoperative period, There was no haemodynamic instability in both the groups in the study period, There was no complication due to the addition of 100μg clonidine to Bupivacaine CONCLUSION: clonidine 100μg (in 2ml)when used as an additive to 0.375% Bupivacaine(30ml) solution for Supraclavicular brachial plexus block, quickens the onset of sensory & motor blockade and prolongs the duration of sensory & motor blockade. It also improves the quality of post-operative analgesia with mild intraoperative sedation and decreases the heart rate without any haemodynamic instability. Hence, clonidine can be considered as a safe additive to local anaesthetic solu...

ABSTRACT:The word Achondroplasia literally means "Without Cartilage Formation". It results from abnormal cartilage formation at epiphyseal growth plates. It is the most common form of short limbed dwarfism. Since it is a congenital short statured disease patient can have respiratory, neurological and cardiac problems associated with and poses many challenges to anaesthesiologists to choose best anaesthetic choice. CASE REPORT: A 27 years old parturient with short stature (3 feet 8 inches) weighing 45.5 Kgs came to the hospital in early labor with 37 weeks of gestation. Patient presenting cephalopelvic disproportion and foetal distress. She had mild lumbar lordosis and very mild scoliosis and the patient known hypothyroid since the beginning of the pregnancy and on treatment. There is no previous history of exposure to anaesthesia and no previous surgical history. Family history reveals, no person in the family has got Achondroplasia. We used low dose Bupivacaine 1.2ml (6mg) along with fentanyl 0.2ml of fentanyl (10 micrograms) for spinal anaesthesia. First attempt was a dry tap followed a successful spinal anaesthesia with adequate block achieved. CONCLUSION: In spite of not many case reports of spinal anaesthesia in Achondroplasia, spinal anaesthesia remains an appropriate option in emergency caesarian section.

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