No abstract

Background: Epidural anesthesia is commonly used for providing both postoperative analgesia in infra umbilical surgeries. An adjuvant increases the effectiveness of the local anesthetic drug by prolonging its action and also causes decreased doses of the local anesthetic agent. Aims: The sight and focus of our study are to juxtapose the effect of clonidine and tramadol as an additive to epidural ropivacaine for postoperative analgesia. Materials and Methods: A randomized, concurrent cohort, prospective study was performed on 60 patients (American Society of Anesthesiologists [ASA] Grade I and ASA Grade II) of either gender, those who were planned for chosen elective infraumbilical surgery under combined spinal epidural anesthesia, and divided into two groups. The patients in Group I were administered 15 mL 0.5% ropivacaine + clonidine (2 μg/kg), whereas Group II patients received 15 mL 0.5% ropivacaine + tramadol (2 mg/kg). Postanesthesia vitals, the duration for motor and sensory effects, i.e., block, adverse effects, and time to rescue analgesia, was recorded. Results: A significant decrease in the heart rate was observed in clonidine group patients compared with tramadol group patients after spinal anesthesia. The duration of motor and sensory block in the tramadol group was significantly longer. Time to rescue analgesia was also prolonged significantly in the tramadol group. The incidence of adverse effects was comparable in the two groups. Conclusion: Tramadol, as an additive to epidural ropivacaine, was found to have a better motor and sensory block, prolonged postoperative analgesia, and minimal adverse side effects. A significantly decreased demand for rescue analgesics was seen compared to clonidine.

Astroblastoma is a rare tumor, which is mostly found in pediatric population. Due to scarcity of literature, the data about treatment is lacking. We are reporting case of brainstem astroblastoma in an adult female. A 45-year-old lady presented with complaint of headache, vertigo, vomiting, and nasal regurgitation for 3 months. On examination, she had weak gag, left hemiparesis. Magnetic resonance imaging brain reported medulla oblongata mass, dorsally exophytic. She underwent suboccipital craniotomy and decompression of mass. Histopathology confirmed diagnosis of astroblastoma. She underwent radiotherapy and recovered well. Brainstem astroblastoma is an extremely rare entity. The surgical resection is possible due to well-defined plane. For best outcome, maximum resection and radiation are indicated.