The surgeries in the upper limb can be done by general or regional anesthesia or both. Nowadays regional anesthesia has wide application in providing surgical anesthesia, complete muscle relaxation, better hemodynamic stability and post-operative analgesia as well as in treating chronic pain syndromes. The sympathetic block produced by regional anesthesia reduces vasospasm. 1 Regional anaesthesia has several advantages in the postoperative period compared with general anaesthesia, including decreased sedation, decreased nausea and vomiting, early discharge from the recovery room and a smooth transition to pain control as the block effects gradually dissipate. Various adjuvants like morphine, fentanyl, sufentanil, dexamethasone, midazolam, ketamine, neostigmine, sodium bicarbonate are added to local anesthetic agents during regional anesthesia. 2 Alpha 2 receptor agonists clonidine and dexmedetomidine are of new interest in regional anesthesia because of their better haemodynamic stability, sedation and longer duration of postoperative ABSTRACT Background: Supraclavicular brachial plexus block is used commonly for upper limb orthopedic procedures. Among the adjuvants used to improve the quality of block induced by bupivacaine the alpha 2 agonists are of new interest. This study was done to compare dexmedetomidine and clonidine as adjuvants to bupivacaine for supraclavicular brachial plexus block in upper limb orthopedic surgeries. Methods: 60 ASA I/II patients aged between 20 and 50 years undergoing upper limb orthopedic procedures were selected and divided into two groups of 30 each. Group C received 35 ml of 0.375% Bupivacaine and clonidine 2µg/kg while Group D received 35 ml of 0.375% bupivacaine and dexmedetomidine 2 µg/kg. Onset time to sensory and motor blockade, vitals, complete duration of motor and sensory block, total duration of analgesia and side effects were noted. Results: The mean time of onset for sensory block and motor block in Group D was lower when compared to Group C. Except at 5 th minute the pulse rate and mean arterial pressure were lower in Group D when compared to Group C. The mean time for total duration of sensory block and motor block was more in Group D when compared to Group C. The total duration of analgesia was higher in Group D than in Group C. Conclusions: The addition of dexmedetomidine to bupivacaine during supraclavicular brachial plexus block produces a shorter onset of time to sensory and motor block with prolonged duration of analgesia when compared to clonidine added to bupivacaine.

Aim:Intubating conditions after Suxamethonium, a time tested popular short acting depolarizing neuromuscular blocking agent, and Rocuronium, a recently introduced intermediate acting non depolarizing neuromuscular blocking agent, with Thiopentone as the sole induction agent, were compared in this study.Materials and Methods:The patients were divided into two groups, each consisting of 30 patients: group a patient's received Rocuronium bromide, 0.6 mg/kg and group B patients received Suxamethonium chloride 1.5 mg/kg. In both the groups, jaw relaxation and vocal cord relaxation were considered for atraumatic laryngoscopy at 60 seconds or, if needed, at 75 seconds and then at 90 seconds.Results:Intubation conditions were rated as excellent in 90% and good in 10% of the patients who received Rocuronium, and excellent in 100% of the patients who received Suxamethonium.Conclusion:It is concluded from this study that intubation can be performed under good to excellent conditions at 60–90 seconds after a bolus dose of Rocuronium of 0.6 mg/kg. The result of this study indicates that this new nondepolarizing neuromuscular blocking agent may be considered as a valuable alternative to Suxamethonium for rapid tracheal intubation, i.e., within 60 seconds, even after induction with Thiopentone as the sole anesthetic agent.

Background: Adjuvants play an important role in enhancing the quality of anesthesia and also in reducing the requirement of primary anesthetic and its related adverse events. Calcitonin is one such adjuvant. But there is still uncertainty regarding the appropriate dose of calcitonin to achieve maximum analgesic efficacy and safety. The current study is conducted to add to the existing evidence on the subject and was aimed to compare the efficacy and safety of two different doses of calcitonin as an adjuvant in patients undergoing spinal anesthesia.Methods: A prospective randomized controlled double-blind trial was conducted in the Department of Anesthesiology and Intensive Care, Sir Sunderlal Hospital, Banaras Hindu University from May 2006 to May 2007. A total of 80 participants aged between 18 to 60 years, with ASA I and II physical status, undergoing infra-umbilical surgeries were randomly allocated to one of the 4 intervention groups. All the 4 intervention groups received 0.5% bupivacaine (H) 3ml as a primary anesthetic agent. Group I and III received 50 IU and 100 IU salmon calcitonin as an adjuvant. Group II received placebo and group IV (control) received no adjuvant. Pinprick test, Bromage scale and 10-point Visual analog scale (VAS) were used to measure the efficacy.Results: All the study groups were comparable with respect to all baseline variables. The time interval to the first dose of analgesia was longest in 100 I.U. calcitonin group, followed by 50 I.U. calcitonin group, placebo control group. The mean duration of analgesia (in minutes) among group I (100I.U. calcitonin) was 230.00±92.39, 159.25±21.59 among group II (Placebo), 161.50±31.20 among group III (50 I.U. calcitonin) and 142.75±20.22 among group IV. Considering group IV (control group) as base line. The differences of duration of analgesia (in minutes) in group I, group II and group III with baseline value (group IV) were statistically significant (P value <0.05). Even though the proportion of subjects developing adverse events was slightly higher in 100 I.U calcitonin groups compared to other groups, they were minor adverse events and were managed appropriately. There were no significant differences across the study groups in terms of hemodynamic stability.Conclusions: Salmon calcitonin as adjuvant increases the duration of postoperative analgesia. Even though the there slightly higher incidence of adverse events with 100 I.U calcitonin they are minor and the risk-benefit ratio favors calcitonin use. To make a categorical recommendation on the appropriate dose, there is further need for large-scale studies and pooled analysis.

Background: In the present day practice of Anesthesiology, bupivacaine is the most commonly used drug for spinal anesthesia. To improve the quality of analgesia and prolong the duration of its action, many adjuvants have been tried. Intrathecal opioids have been found to fulfil both these objectives. This study was done to evaluate the effects of adding sufentanil to bupivacaine for spinal anesthesia. Methods: 100 ASA grade I/II patients aged between 20-60 years undergoing elective lower abdominal, urologic, lower limb surgeries were selected and divided into two groups of 50 each. Group A received 2.5 ml of heavy Bupivacaine, whereas the second group B received 2.5 ml of heavy Bupivacaine with 5 µg Sufentanil. Parameters-Onset and duration of sensory block and motor block, time for two dermatomal segments regression, duration of analgesia, vitals and side effects were assessed. Results: There was no variation in onset of sensory blockade and motor blockade. The time to achieve peak sensory level was 3 minutes earlier in group B. The time for two segment regression and the time to full sensory and motor recovery were prolonged in Group B. Duration of complete and effective analgesia prolonged by 40-60 minutes and the time for first request of analgesic postoperatively was delayed by 70-80 minutes in group B. The quality of analgesia was better in group B. Pruritus was the common side effect in group B. Conclusions: Sufentanil potentiates bupivacaine spinal anesthesia by increasing the duration and improving the quality of analgesia with minimal side effects.