AIMS:Brachial plexus nerve blocks have analgesic and opioid sparing benefits for upper extremity surgery. Single-injection techniques are limited by duration of local anaesthetic agents, however Continuous block techniques can be used for prolonged anaesthesia and analgesia but it presents management challenges. The study was designed to compare the effects of dexamethasone administered as an adjunct to bupivacaine in supraclavicular brachial plexus block on the onset,duration and postoperative analgesia following upper limb surgeries. METHODS AND MATERIAL: A prospective, double-blind study was undertaken in patients scheduled for upper limb surgeries under supraclavicular brachial plexus block. Sixty patients were randomly divided into two groups, Group B and BD.Group B received 30 ml of 0.375% bupivacaine with 2 ml normal saline while Group BD received 30 ml of 0.375% bupivacain with 2ml(8mg) dexamethasone for supraclavicular brachial plexus block. The groups were compared regarding quality of sensory and motor blockade, duration of post operative analgesia and intra and postoperative complications. RESULTS: There was a significant increase in duration of motor and sensory block and analgesia in Group BD as compared to Group B patients(P < 0.0001). No significant side effects were noted. CONCLUSIONS: The addition of 8 mg of dexamethasone to bupivacaine in supraclavicular brachial plexus block prolongs the duration of motor and sensory block and extends the analgesia period.KEYWORDS: Anaesthesia adjuvants; Dexamethasone; Brachial plexus block. INTRODUCTION:Brachial plexus block is a suitable alternative to general anesthesia for elbow, forearm and hand surgery. (1) Local anaesthetics alone does not provide analgesia for more than 4-8 hours Prolonging the duration of sensory and motor blockade of regional anaesthetic techniques is often desirable to provide intra operative anesthesia and analgesia in the post operative period without any systemic side effects. Several adjuncts have been studied to potentiate efficacy of brachial plexus block including opioids, midazolam, neostigmine, bicarbonate,hyaluronidase and α2 agonists. (2,3,4) Perineural injection of steroids is reported to influence post operative analgesia.They relieve pain by reducing inflammation and blocking transmission of nociceptive C-fibres and by suppressing ectopic neural discharge. Some studies have demonstrated the analgesic effect of local spinal and systemic corticosteroids in combination with bupivacaine. (5,6,7) The study was designed to compare the effects of dexamethasone administered as an adjunct to bupivacaine in supraclavicular brachial plexus block on the onset,duration and postoperative analgesia following upper limb surgeries.

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Survival after nylon rope suicidal hanging is a rare occurance. We describe here a patient who attempted suicide by nylon rope hanging and developed post obstructive pulmonary edema was managed successfully. Patient recovered completely with ventilatory support in next 60 hours without any neurological deficit.This case highlights an unusual complication of hanging and its recovery. KEYWORDS: Post obstructive pulmonary edema,cerebral edema, Nylon rope attempted suicidal hanging. KEYMESSAGES: Patient was lucky enough to be rescued and brought to the hospital early, even after nylon rope attempted suicidal hanging. Such cases need to be managed aggressively as there are chances of their complete recovery INTRODUCTION:Depression is increasing at an alarming rate globally. (1,2,3) Hanging is one of the oldest and common mode of suicide in the young adults. Death takes about 8-10 minutes in such cases. (4) The mortality and morbidity change dramatically if such patients are rescued early and managed aggressively, even in small ICUs. Here we report a case who presented in severe pulmonary and cerebral edema after attempted suicidal nylon rope hanging.

SummaryThe timing of drug ingestion over 24 hours was assessed in 58 outpatients taking drugs three times daily. The mean time between 1st and 2nd dose was 5.7 hours, 2nd and 3rd 6.1 hours and between 3rd and 1st of the next day 12.2 hours. Based on a simulation of hydralazine pharmacokinetics, such irregular administration would increase peak levels by 10% and decrease trough levels by 64% compared with regular 8-hourly doses.

Background: Failure/delayed effect of spinal anesthesia were noted in several patients with past history of scorpion sting during routine practice. Scorpion venom is known to delay the activation of sodium neuronal channels. Local anesthetic agents also act through the sodium channels. Therefore this study was conducted to test the association of scorpion sting with failure/resistance to effect of spinal anesthesia. Methods: 40 patients in the age range of 18-80 years were divided into two equal groups. Group 1 with past history of one or multiple scorpion stings and group 2 with no such history. The anaesthetic management was identical i.e. subarachnoid block with 3.5 ml. 0.5% Bupivacaine heavy. The onset of sensory and motor block was noted. Peaks of sensory and motor blocks were also observed. Sensory block was assessed by pin prick method and motor block by Bromage scale. After waiting for 20 min, general anesthesia was administered if the block was inadequate. Results: The time of onset of sensory and motor block as well as the time for the peak of sensory and motor blocks was significantly prolonged in scorpion sting group. 5 patients had failed sensory and motor block. All the patients in control group had adequate subarachnoid block. Conclusion: There is a direct association between previous scorpion sting and development of resistance to the effect of spinal anesthesia.