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Background:Various analgesic modalities have been used for postoperative analgesia in patients undergoing inguinal hernia surgery. In this randomized clinical trial, we have compared the analgesic efficacy of transversus abdominis plane (TAP) block with that of ilioinguinal/iliohypogastric (IIIH) nerve block with wound infiltration in patients undergoing unilateral open inguinal hernia repair.Aim:The primary objective of this study was to compare the efficacy of postoperative analgesia of ultrasound-guided TAP block and IIIH block with wound infiltration (WI) in patients undergoing open inguinal hernia surgery.Settings and Design:This was a randomized clinical trial performed in a tertiary care hospital.Materials and Methods:Sixty patients scheduled for hernia repair were randomized into two groups, Group T and Group I. Postoperatively, under ultrasound guidance, Group T received 20 ml of 0.25% ropivacaine – TAP block and Group I received 10 ml of 0.25% ropivacaine – IIIH block + WI with 10 ml of 0.25% ropivacaine. The primary outcome measure was the time to rescue analgesia in the first 24 h postoperatively. Fentanyl along with diclofenac was given as first rescue analgesic when the patient complained of pain.Statistical Analysis:Statistical comparisons were performed using Student's t-test and Chi-square test.Results:Mean time to rescue analgesia was 5.900 ± 1.881 h and 3.766 ± 1.754 h (P < 0.001) and the mean pain scores were 5.73 ± 0.784 and 6.03 ± 0.850 for Group TAP and IIIH + WI, respectively. Hemodynamics were stable in both the groups. One-third of the patients received one dose of paracetamol in addition to the rescue analgesic in the first 24 h. There were no complications attributed to the block.Conclusion:As a multimodal analgesic regimen, definitely both TAP block and IIIH block with wound infiltration have a supporting role in providing analgesia in the postoperative period for adult inguinal hernia repair. In this study, ultrasound-guided TAP block provided longer pain control postoperatively than IIIH block with WI after inguinal hernia repair. There were no complications attributed to the blocks in either of the group.

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Context: Midazolam and propofol are effective sedatives for use in upper gastrointestinal endoscopy (UGIE); however, their utility is limited when used alone. In this regard, dexmedetomidine seems to be a promising sedative. Aims: The aim was to compare the hemodynamic effects and sedation efficacy of these drugs in patients undergoing elective diagnostic UGIE. Settings and Design: Randomized control double-blind study was conducted at a teaching hospital. Subjects and Methods: Patients belonging to ASA Grade I or II, undergoing diagnostic elective UGIE were enrolled in the study and randomized into three groups; Group I received midazolam infusion, Group II received propofol infusion and Group III received dexmedetomidine infusion. Hemodynamic parameters and adverse events were recorded during the procedure (intra-operative period [IOP]). Both patient and endoscopist satisfaction were rated on visual analog scale (0 = no pain/least difficulty to 10 = worst pain/maximum difficulty). Recovery was recorded as time to achieve modified Aldrete score of 10/10. Statistical Analysis: Parametric test analysis of variance was applied to compare the means of three groups of continuous data. Results: Ninety patients were analyzed. Mean arterial pressure was significantly lower in the propofol group at IOP2, IOP4, IOP8, and IOP10 compared with dexmedetomidine and midazolam group. The endoscopist satisfaction level was significantly higher in dexmedetomidine group as compared to propofol and midazolam (60%, 56.7%, 13.3%; P < 0.001). Significantly faster recovery was observed in dexmedetomidine group compared to midazolam and propofol group (7.7 ± 3.9, 18.3 ± 3.8, 12.7 ± 2.9 min; P = 0.001). Conclusions: Use of dexmedetomidine was associated with greater hemodynamic stability and faster recovery when compared to propofol and midazolam.