BACKGROUND Presence of pain is as old as that of humankind. From ancient times, pain has followed surgeons as well as anaesthesiologists like a shadow which is not seperable.1 Postoperative pain is an acute pain which can affect nearly all organ functions and can leads to postoperative period morbidity and mortality. Pharmacological treatment using intravenous opioids is an effective and popular method to treat the pain.2 In this study the researcher compared the analgesic efficacy and side effects of intravenousNalbuphine and Tramadol in those patients undergoing Lower limb Orthopaedic procedures. To investigate the effect of Nalbuphine and Tramadol on post-operative pain and to compare the side effects among Nalbuphine and Tramadol group in patient admitted in Travancore Medical College, Kollam during the period from January 2019 to September 2019. METHODS This study was a prospective observational study. The study population comprises, 140 patients falling within the inclusion criteria who had given consent for participating in this study. Sub arachnoid block is commonly followed in our Anesthesiologydepartment for Lower limb orthopaedic procedures 3 to 3.5ml of 0.5% hyperbaricbupivacaine via 25 G spinal needle. No analgesic or sedative will be given intra operatively.Patients who had received Injection Nalbuphine 0.15 mg/kg IV diluted till 10 ml volume innormal saline and Injection Tramadol 2 mg/kg IV diluted till 10 ml volume of normal salinewere grouped as N (n=70) and T (n=70) respectively. Post-operative pain was assessed usingVAS, onset of drug effect and duration of action of each dose of drug. Side effects of drugsassessed using the variables such as incidence of postoperative nausea and vomiting (PONV),Ramsay sedation scores, respiratory rate and SpO2. VAS score assessed initially every5 minutes till 15 minutes, then every 30 minutes till 2 Hrs, then 3 Hrs, 4 Hrs, 5 Hrs, 6 Hrs,8 Hrs, 12 Hrs, 16 Hrs, 20 Hrs and 24 Hrs. Ramsay sedation scores, respiratory rate and SpO2 were assessed initially every 5minute till 15minutes, every 30minute till 2 hours, then at 4 Hrs, 6 Hrs, 8 Hrs, 12 Hrs,16 Hrs, 20 Hrs and 24 Hrs duration. RESULTS From the results we found that with successive doses it Nalbuphine proven to be having significantly longer duration of analgesia than Tramadol after the third dose. Based on the VAS scores Group T is more effective in controlling pain initially, butlater on pain scores significantly less with Group N became more effective. Side effects likenausea and vomiting is comparable between two groups but incidence more in Group T.Respiratory depression side effects is also comparable between the two groups but incidencemore for Group N. CONCLUSIONS Nalbuphine 0.15 mg/kg can be an effective tool in the treatment of acutepostoperative pain in lower limb orthopaedic procedures. Both Nalbuphine and Tramadol canbe a good alternative in the multimodal therapy of acute postoperative analgesia. KEY WORDS Nalbuphine, Tramadol, Lower Limb Orthopaedic Surgeries, Sub Arachnoid Block

BACKGROUND Direct laryngoscopy and endotracheal intubation frequently induce a cardiovascular stress response characterized by hypertension and tachycardia due to reflex sympathetic discharge due to laryngotracheal stimulation which leads to increased plasma nor epinephrine concentration. The response is transient occurring 30 seconds after intubation and lasting for less than 10 minutes. Laryngoscopy and endotracheal intubation are associated with undesirable haemodynamic response which is of little significance in healthy patients but may be detrimental in patients with systemic diseases like hypertension, ischemic heart disease, stroke, perforated eye injury, increased intracranial tension etc. There is a need to attenuate these haemodynamic changes to decrease the mortality and morbidity. This study is designed to evaluate the attenuation of the haemodynamic response to laryngoscopy and endotracheal intubation with available cost effective drugs (esmolol and lignocaine) which are routinely used. METHODS This was an observational study conducted in the department of anaesthesiology, Travancore Medical College, Kollam among 140 patients in the age group 18 to 65 years posted for elective surgery from October 2017 to September 2018. Patients who received lignocaine or esmolol as intravenous agent prior to the induction of anaesthesia were recommended to group ‘L’ and ‘E’ respectively. Blood pressure and heart rate was recorded prior to laryngoscopy as well as 1 minute, 3minutes, 5 minutes and 10 minutes after laryngoscopy and intubation. Collected data was tabulated and analyzed using appropriate statistical software (SPSS20). RESULTS The rise in heart rate, systolic BP, diastolic BP, and mean arterial pressure were better controlled by esmolol than lignocaine. CONCLUSIONS Intravenous esmolol 1.5mg/kg is found to be more effective in the attenuation of hemodynamic responses to laryngoscopy and endotracheal intubation than intravenous lignocaine 1.5mg/kg. KEY WORDS Laryngoscopy, Intubation, Attenuation, Cardiovascular Response, Lignocaine, Esmolol

BACKGROUND Regional anaesthesia has become the preferred technique for caesarean section because of higher incidence of maternal mortality and morbidity associated with general anaesthesia. Spinal hypotension occurs as a result of sympathetic blockade and decreased venous return due to decreased systemic vascular resistance and venous pooling. Such episodes of hypotension have been shown to cause decreased Apgar scores and foetal acidosis. Preloading with intravenous fluids, left uterine displacement and prophylactic/ therapeutic vasopressors have all been used in the prevention and management of hypotension traditionally. However no single method has been proved satisfactory. In terms of neonatal and maternal outcomes, prevention of hypotension is considered superior to treatment of established hypotension. In this study, we compare the efficacy of preloading of crystalloids with Ephedrine infusion in prevention of hypotension following spinal block in caesarean patients. Objectives- Primary objective is to determine the incidence of hypotension following spinal anaesthesia in patients receiving preloading with crystalloids and preloading with Ephedrine. Secondary objective is to compare intraoperative maternal and foetal adverse effects of pre-treatment with crystalloids and Ephedrine. METHODS An observational study was conducted in 90 patients belonging to ASA I and II categories undergoing elective LSCS. One category received 10ml/kg Ringer Lactate and other category 10mg Ephedrine in 10ml/kg Ringer Lactate 15-30 minutes prior to spinal block. All patients received SAB with 22.2ml 0.5% Bupivacaine heavy at L3-L4 space. HR and BP were monitored periodically and fall in MAP of ≥20% was noted and managed with rescue Ephedrine. Maternal adverse events, foetal APGAR scores and umbilical blood gas analysis noted. RESULTS Incidence of hypotension was significantly less in Ephedrine category as compared to crystalloid category. Incidence of maternal adverse events as well as foetal parameters was not significantly different. CONCLUSIONS Preloading with Ephedrine decreases the incidence of maternal hypotension when compared to crystalloids alone. KEY WORDS Caesarean Section, Crystalloids; Ephedrine, Foetal Acidosis, Mean Arterial BP, Preloading, Spinal Hypotension.