The year 2020 saw the rise of an influenza-like illness from SARS-nCoV2 (Severe Acute Respiratory Illness by novel Coronavirus 2), which causes myriad of symptoms in patients, ranging from mild upper respiratory symptoms to severe ARDS (Acute Respiratory Distress Syndrome). It is, however, known to cause high morbidity and mortality in patients with underlying comorbidities like diabetes, hypertension, kidney disease, obesity and malignancies. Amongst these, the subset with haematological malignancies has an especially poor prognosis possibly as a result of immune suppression, due to underlying bone marrow depression as well as effects of chemotherapeutic agents. These patients need frequent visits and admissions to the hospital for treatment, thus exposing them to the risk of acquiring the infection. Also, a high index of suspicion, with low threshold for testing is needed in view of possible atypical presentation and symptoms. These patients may also warrant an early ICU admission, as they tend to develop severe disease with ARDS more frequently, with an overall poor prognosis and high mortality rate. We hereby present a series of six patients with underlying haematological malignancies who were admitted in our ICU with a serious COVID-19 illness and a grave outcome.

Background: Total knee replacement (TKR) is associated with intense post-operative pain. Providing both optimal analgesia and early mobilization are vital for the patient. We hypothesized the adductor-canal-block, being a pure sensory block, provides a longer ambulation distance by patient when compared with femoral nerve block as the latter causes both sensory and motor block. Method: Patients aged 30-80 years scheduled for TKR were included in this randomized controlled trial. The patients were divided into two groups, one received a continuous adductor-canal-block(n=25)and other group received continuous femoral nerve block(n=25) via a catheter with continuous infusion of 0.2% Ropivacaine at the rate of 5-10 ml/hour. During the next 24 hours VAS and MMT score were calculated at different intervals. 10 metre ambulation distance covered by patients was measured after 24hr of surgery. Result: 50 patients were analysed using student t test. The Visual Analogue Scale and Manual Muscle Testing score were noted during 24-hour period post-op. There was a significant difference among the VAS scores in the two groups at 2 hours post-op period only. The MMT was significantly different at 2 instances – 6 and 12-hours post-op. The ambulation distance post-24-hours surgery showed no significant difference between the two groups. Conclusion: Based on our study it can be concluded that either ACB or FNB can be administered to the patients as both blocks are almost equally effective in terms of ambulation distance after 24 hrs of surgery and pain relief in post-operative period. Keywords: Total knee replacement, Adductor canal block, Femoral nerve block, Ambulation distance, VAS and MMT.