Traditionally Supraclavicular Brachial plexus block is the commonly performed block for upper extremity surgeries. The Problems associated with this technique include inadequate block, failed block, direct injury to the nerves, pneumothorax, phrenic nerve palsy and vascular puncture etc. Recently lateral approach for supraclavicular brachial plexus block is gaining popularity because of its less complications and high success rate. The aim of the study is to compare the efficacy of lateral approach with conventional approach for supraclavicular brachial plexus block. METHODS: Fifty patients of ASA grade I and II scheduled for upper extremity surgery (below the midarm) were randomly allocated into two groups of 25 each. Group C was randomly allocated to receive supraclavicular brachial plexus block by conventional approach. Group L was randomly allocated to receive supraclavicular brachial plexus by lateral approach. Both the groups were given 10ml of 1.5% lignocaine and 15ml of 0.5% ropivacaine (total volume 25 ml).The parameters assessed were the onset and duration of sensory and motor blockade, time taken for the procedure, need for supplementation of anaesthesia, adverse effects, tourniquet tolerance and success rate. Statistical analysis was done using appropriate tests, (p<0.05) was considered statistically significant. We concluded that lateral approach for supraclavicular brachial plexus block using peripheral nerve stimulator, is a better alternative to conventional approach in terms of higher success rate and lesser complication rate. KEYWORDS: Brachial plexus block, Lateral approach supraclavicular brachial plexus block, Nerve stimulator, Lignocaine, Ropivacaine. INTRODUCTION:Brachial plexus block is a popular technique for upper limb surgeries, postoperative and chronic pain management. 1 Supraclavicular brachial plexus block is the common approach used for upper limb surgeries below the mid humerus. 2 The major advantage of supraclavicular block is that, the nerves are tightly packed in this area giving a very fast and deep block. Hence it is called as "The Spinal of the Arm". 3 However this approach has its own complications like direct injury to the nerves, puncture of subclavian artery, pneumothorax etc. 4 Recently lateral approach for supraclavicular brachial plexus block has gained popularity because of its low side effect profile and higher success rate compared to conventional approach. 5 Dr. Dilip Kothari has described this lateral approach for supraclavicular brachial plexus block and demonstrated that it was associated with minimal complications and high success rate.Ultrasound guided nerve blocks are being routinely done now a days, 6 however due to unavailability of ultrasound in our operating rooms, the present study was carried out using a nerve Page 8662 stimulator guided technique. 7,8 The aim of our study was to compare lateral approach with conventional approach for supraclavicular brachial plexus block, in terms of characteristics of sensory and motor blockade, success rate and comp...

BACKGROUND: Appendectomies and lower abdominal surgeries are associated with significant postoperative pain in children. Transversus Abdominis Plane (TAP) block provides effective analgesia for patients undergoing lower abdominal surgeries. Our aim is to evaluate its analgesic efficacy for lower abdominal surgeries in children when compared to standard systemic analgesia. METHODOLOGY: After institutional Ethics Committee approval, 50 children, ASA I/II 7-13 yrs. undergoing lower abdominal surgeries were randomized into groups A and B of 25 each. All patients received standard General Anesthetic with standard monitoring. In Group A, TAP block was performed under land mark technique with 2.5mg/kg of 0.5% ropivacaine which is equivalent to 0.3ml/kg after General Anesthesia. In Group B, standard systemic analgesia was given which served as the control group. In addition, patients of both groups received regular IV paracetamol 15mg/kg immediately after completion of surgery. STATISTICS AND RESULTS: Statistical analysis was performed with student's t-test and Fisher's exact test. P<0.05 was considered significant. TAP block with ropivacaine reduced mean tramadol requirements in the 1 st 24hrs postoperative period [42+15.89 vs. 80.35+19.16mg; p<0.001]. Postoperative VAS scores significantly reduced in TAP block group until 24hrs after surgery. No complications were reported with TAP block in our study. CONCLUSION: Land mark based TAP block, as a part of balanced analgesia regimen provides superior analgesia than systemic analgesia alone in children undergoing lower abdominal surgeries.

BACKGROUND: Opioid based analgesic regimens have been the gold standard for post caesarean analgesia until recently. Regional techniques like local intra-wound infusion techniques are becoming popular now. Our aim is to evaluate the efficacy of 0.2% Ropivacaine continuous wound infusion versus continuous epidural versus conventional systemic analgesia for post caesarean delivery. METHODOLOGY: 60 healthy parturients of ASA I/II were randomized after elective caesarean section into 3 groups of 20 each. Group-A: Received 0.2% Ropivacaine via an epidural catheter placed into subcutaneous tissue and fascia before skin closure at the rate of 5ml/hr. through infusion pump. Group-B: Received 0.2% Ropivacaine continuous epidural infusion via an epidural catheter at the rate of 8ml/hr. An initial bolus of 10ml was given in groups A&B. Group-C: Received standard systemic analgesia with diclofenac sodium and rescue opioid. Post operatively parturients were assessed for VAS scores for pain at rest and during movement, total Ropivacaine consumption, Tramadol consumption and side effects. Data were analyzed using SPSS software version 22. RESULTS: There were no significant differences in the mean VAS scores at rest and at movement between groups A or B and C. The consumption of Tramadol was significantly greater in Group C (p value AC=0.025, BC=0.0000) than A or B. Mean Ropivacaine consumption is significantly higher in Group B (p=0.000) than Group A. CONCLUSION: Continuous local intra-wound analgesia with Ropivacaine produced comparable analgesia to that of continuous epidural and superior analgesia compared to standard systemic analgesia.

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Background: Now a days, Ultrasound has been the gold standard and an invaluable tool in the field of regional anaesthesia, especially for upper limb and truncal blocks where general anesthesia is associated with high risk and also in patients posted for general anesthesia with anticipated difficult airway. Recently, few studies have published the importance of Ultrasound in the evaluation of airway and related procedures. Aim of this study is to evaluate the use of USG guided indices for prediction of difficult airway in obese patients and correlating them with clinical parameters. Methods: This study was a prospective observational study done in a tertiary health care center, Government General hospital, Kakinada over a duration of two months from August 2022 to September 2022. Eight Ultrasound parameters like tongue thickness, skin to hyoid distance, pre-epiglottic space, skin to midpoint of vocal cords, skin to thyroid isthmus, anterior soft tissue thickness at suprasternal notch, hyomental distance and thyromental distance were correlated with clinical evaluation (Cormacke-lehane grading) in this study and conclusions were drawn. Results: Out of 30 cases studied, 20 (70%) were predicted to be difficult with Ultrasound airway examination and 16 (53.3%) were found to have difficulty in intubation clinically. Conclusions: The following USG indices like pre-epiglottic space, Skin to midpoint of vocal cords, Anterior soft tissue thickness at Suprasternal notch, Hyomental distance in mid-extended position and thyromental distance were found to be clinically correlated to predict difficult airway and intubation in obese patients.