Certain adjuvants have been tried with local anaesthetics to enhance analgesic efficacy and extend the analgesic period post operatively. This randomized prospective double blind trial was designed to compare the effects of addition of clonidine to ropivacaine in interscalane brachial plexus block for upper limb surgery. Patients and methods: 60 patients of age group 20-65 years of either sex, admitted to undergo upper limb surgeries were included. Group A-Patients receiving 30ml of 0.75% ropivacaine hydrochloride plus 1ml normal saline. Group B-Patients receiving 30ml of 0.75% ropivacaine hydrochloride plus 150mcg clonidine (1ml). Results: The total duration of sensory block in group A was 7.61 + 1.62 hours while in group B was 11.62 + 1.84 hours. Total duration of motor block in group A was 5.95 + 1.38 hours while in group B was 9.82 + 1.98 hours. Duration of post-operative analgesia in group A it was 7.24 + 1.36 hours and in group B it was 11.83 + 2.33 hours. Haemodynamically both groups were stable perioperatively. Patient satisfaction score was better in group B. Conclusion: In conclusion, clonidine added to ropivacaine is an attractive option for improving the quality and duration of interscalene brachial plexus block in upper limb surgeries with stable perioperative hemodynamics.

BACKGROUNDThe introduction of safe drugs enhanced the popularity of spinal anaesthesia. Lofgren and Lundqvist introduced the most commonly used drug, Lignocaine. One of the disadvantages of Lignocaine was the association with transient neurological symptoms, which presents as low backache and lower extremity dysesthesia. Bupivacaine was introduced by Ekenstam in 1957. It is a well-established long-acting local anaesthetic used for spinal anaesthesia. It has been used frequently in spinal anaesthesia with a very little incidence of transient neurological symptoms. But it is associated with cardiovascular and central nervous system toxicity when used in high concentration or when accidentally administered intravascularly. Ropivacaine was introduced into clinical practice in 1996. It was initially used in epidural anaesthesia in lower extremity surgery, where it was compared with bupivacaine where they concluded that ropivacaine produced similar sensory and motor blockade with less cardiotoxicity. In a study, different concentrations of intrathecal ropivacaine 0.5% and 0.75% were compared for vascular surgery, which concluded that 15 mg of plain ropivacaine 0.75% is effective and safe and gives complete spinal anaesthesia in high risk patients without side effects and cardiovascular modifications.The aim of this study was to compare and evaluate the haemodynamic changes and side effects associated with equal volumes of two different doses of ropivacaine hydrochloride (0.75% and 0.5%) used in spinal anaesthesia in lower limb orthopaedic surgeries.

BACKGROUNDCentral neuraxial blockade is a major regional anaesthesia technique with a long history of effective use for a variety of surgical procedures and pain relief. Ropivacaine is an amino-amide local anaesthetic drug, which was first synthesised in 1957 and was introduced into clinical practice in 1996. As there are limited studies on effect of ropivacaine in spinal anaesthesia, we conducted a dose comparison study of ropivacaine in our institute to know the clinical efficacy and safety with regard to better patient profile management.The aim of the study was to compare and evaluate equal volumes of two different doses of ropivacaine hydrochloride (0.75% and 0.5%) in spinal anaesthesia in lower limb orthopaedic surgeries with regard to the onset and duration of sensory and motor blockade. MATERIALS AND METHODSIt is a prospective, randomised, double-blind study conducted in a tertiary care hospital in which 80 patients of age group 20 -65 years of either sex which were scheduled to undergo lower limb orthopaedic surgeries under spinal anaesthesia with two different doses of Ropivacaine Hydrochloride were included. The patients were randomly divided into 2 groups of 40 each. Group A received 22.5 mg (3 mL) of 0.75% isobaric Ropivacaine Hydrochloride. Group B patients received 15 mg (3 mL) of 0.5% isobaric Ropivacaine Hydrochloride. RESULTSRopivacaine 0.75% produced higher level and longer duration of sensory blockade than ropivacaine 0.5% when used in spinal anaesthesia. Thus, there was longer duration of analgesia with ropivacaine 0.75%. The ropivacaine 0.75% solution resulted in higher frequency and longer duration of motor block in the lower limbs than ropivacaine 0.5%. Thus, a reliable motor blockade was obtained with ropivacaine 0.75%. Therefore, it is concluded that intrathecal ropivacaine 0.75% provides an excellent sensory blockade with longer duration of analgesia and a complete motor block, which makes it suitable for lower limb orthopaedic surgeries requiring an intense sensory and motor blockade. CONCLUSIONOur study suggests the use of ropivacaine 0.75% for spinal anaesthesia in lower limb orthopaedic surgeries, as it provides prolonged duration of sensory and profound motor blockade of lower limbs.