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This study was aimed to assess the efficacy of patient controlled analgesia using continuous infraclavicular brachial plexus in upper limb surgeries, to study the amount of rescue analgesics used and to study the associated complications and sleep disturbances in patients underwent upper extremity orthopaedic surgery. MATERIALS AND METHODSA prospective randomized clinical study was done on 60 patients undergoing upper limb below mid shaft of humerus surgeries. Sixty patients belonging to ASA-Physical status 1-2 were selected for study and randomly allocated to two groups of 30 each. Group A received patient controlled analgesia with continuous infusion of 0.2% ropivacaine through infraclavicular catheter (P Group). Group B received patient controlled analgesia with continuous infusion of 0.9% normal saline through infraclavicular catheter (C Group). RESULTSPatients received ropivacaine experienced significantly less postoperative pain compared with patients received normal saline during rest at all-time intervals except at the baseline. Patients in the C group received first top-up in 5-6 hours, whereas 6 patients in the P group received their first top-up after 10 hours and 22 patients received after 12 hours. In the Group P, patients experienced no sleep disturbances compared to the placebo group. CONCLUSIONThis randomized, double-blinded, placebo-controlled study shows us that postoperative analgesia is achievable using a perineural infusion of ropivacaine via an infraclavicular brachial plexus catheter after moderately painful upper extremity surgery. Hence, patients experienced a significant decrease in sleep disturbances, analgesic use and narcotic-related side effects.

ABSTRACT:The Airtraq is designed to allow visualization of the glottis without alignment of the oral, pharyngeal, and laryngeal axes. The Airtraq differs in many ways from the conventional Macintosh laryngoscope and is suiTable scope for managing anticipated/unanticipated difficult airway situations. Here tracheal intubation performance of standard Macintosh laryngoscope was compared with Airtraq in normal patients. METHODS: Sixty patients (ASA I and II) who required surgery under general anesthesia were selected. They were randomized to intubation with the Macintosh laryngoscope or the Airtraq laryngoscope. Induction of Anaesthesia was standardized. Time taken for intubation, hemodynamic changes during intubation and ease of visualization of vocal cords (Using Cormack-Lehane grading) was compared between the groups. RESULTS: Preoperative characteristics of the patients were similar in both groups. In the Airtraq group, tracheal intubation time using Airtraq was 10.97 seconds when compared to Macintosh laryngoscope where the time was 13.07 seconds (P= 0.001). Pulse rate in both groups were in the same range before or after intubation, but change in blood pressure was more in Macintosh group (P=0.004). In Airtraq group all patients had Cormack-Lehane grading I, and only 2 patients had Cormack-Lehane grading of II and III in Macintosh group. CONCLUSION: In this study, the Airtraq laryngoscope shortened the duration of tracheal intubation and provided better intubating conditions when compared with standard Macintosh laryngoscope.

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