Background and objectives: Decreasing the dose of intrathecal Bupivacaine may be useful to provide surgical anaesthesia with less hemodynamic disturbances especially in elderly patients but may be associated with inadequate anaesthesia for orthopaedic surgeries to perform. This can be overcome by adding Fentanyl to it. Materials and method: 60 elderly patients of American Society of Anaesthesiologists (ASA) grade II, scheduled for femur surgeries were randomly assigned to one of the two groups. Group B:(n=30) patients receiving Bupivacaine (0.5%) heavy 2.5ml (12.5mg) and Group BF:(n=30) patients receiving Bupivacaine (0.5%) heavy 1.5ml (7.5mg)+Fentanyl (25ug) 0.5ml+0.5 ml normal saline, total volume being 2.5ml. The characteristics of sensory and motor blockade, duration of effective analgesia, perioperative hemodynamics and complications were recorded. Results: The mean onset of sensory block and time to achieve peak sensory level was early, time to achieve regression to L1 level and duration of effective analgesia was longer in group BF ad the difference was highly significant (p<0.001). There was no significant difference in motor blockade characteristics between two groups. Incidences of hypotension were more in group B compared to group BF. Conclusion: Low dose intrathecal bupivacaine (7.5 mg) with fentanyl (25mcg) can provide adequate surgical anaesthesia and better hemodynamics and can be used in elderly patients for femur surgeries.

Background: The complex innervation of the hip joint may require a combined peripheral nerve block technique for perioperative effective analgesia and early recovery. The pericapsular nerve group (PENG) and suprainguinal fascia iliaca compartment blocks (SIFICB) are interfascial plane blocks aiming to involve the femoral, obturator, accessory obturator, and lateral femoral cutaneous nerves. The data still lacks in providing the standard of care for patients undergoing hip surgery. In this case series, we studied the efficacy of ultrasound-guided combined PENG block and SIFICB for perioperative analgesia and functional recovery in patients posted for hip surgery.Method: We studied 10 adults of either gender who underwent close reduction and internal fixation of hip fracture. Before receiving spinal anesthesia, all patients had PENG block and SIFICB with 10 ml and 20 ml of local anesthetics respectively. Patients were observed for ease of giving sitting position for spinal anesthesia (EOSP), visual analogue score (VAS) at rest and 15° leg elevation, duration of postoperative analgesia, the cumulative requirement of rescue analgesic at 48 hours and ability of patients to undergo weight-bearing trial postoperatively.Result: The static and dynamic VAS before receiving spinal anesthesia and postoperatively, was reduced compared to pre-block. The optimal position for delivering spinal anesthesia was possible to achieve as the patients were able to sit comfortably after 10 minutes of receiving both blocks. Duration of postoperative analgesia also extended up to 18 hours with the cumulative requirement of injection tramadol restricted to two doses postoperatively. All were able to walk down a minimum of 55 steps after 48 hours of completion of surgery. Conclusion:Combining PENG block along with SIFICB is effective in the provision of perioperative analgesia with a considerable reduction in opioids and enhanced functional recovery due to motor sparing effect after surgical repair of the hip fracture.

Introduction: Femoral Nerve Block (FNB) renders marked postoperative analgesia in patients undergoing knee surgery and use of adjuvant to Local Anaesthetic (LA) agent is more advantageous in lengthening duration of sensory effect of block. Aim: To evaluate the effect of addition of dexmedetomidine to 0.2% Ropivacaine in FNB. Materials and Methods: The randomised clinical trial was conducted at Medical College and SSG Hospital, Vadodara, Gujarat, India which included 60 patients of either sex, American Society of Anaesthesiologists (ASA) Grade-I,II,III posted for open knee surgery. Patients were randomly allocated to two groups-Group RD patients received 0.2% ropivacaine 20 milliliter (mL) with dexmedetomidine 2 mL (50 μg) and Group R received 0.2% ropivacaine 20 mL with normal saline 2 mL for FNB. Duration of postoperative analgesia, total requirement of systemic rescue analgesic in 24 hours, vital parameters and complications were observed. Statistical analysis was done with Medcalc 14.8.1 statistical software. A p<0.05 considered as significant. Result: Duration of analgesia was significantly longer in Group RD (484±26.98 min) than in Group R (338±29.40 min), p<0.0001. Mean postoperative cumulative requirement of analgesic (Tramadol) was lesser in Group RD (207±25 milligram (mg)) than in Group R (290±30 mg), p<0.0001. Conclusion: Dexmedetomidine to ropivacaine 0.2% for FNB significantly augments duration of analgesia and reduces requirement of systemic analgesic declining its unfavourable effect.