BACKGROUND Routine upper GI endoscopy is the standard practice to diagnose oesophageal, gastric and duodenal diseases. The Upper GI Endoscopy may be performed with or without conscious sedation using topical pharyngeal anaesthesia alone. But patient's tolerance to procedure and endoscopist satisfaction increases when sedation is used along with topical pharyngeal anaesthesia. 1 The present study is to compare the haemodynamic effects and sedation efficacy of fentanyl with propofol and fentanyl with dexmedetomidine in patients undergoing elective diagnostic upper gastrointestinal endoscopy (UGIE). MATERIALS AND METHODS This is a randomized prospective comparative study. It was undertaken at Viswabharathi Hospital, Kurnool among 60 patients during the period of October 2014 to October 2016. RESULTS The patients were assigned into two groups of 30 each. Group P (n=30) received Propofol to achieve desired level of sedation and Group D (n=30) received Dexmedetomidine. There was statistically significant difference between groups with regard to induction time, recovery time and endoscopist satisfaction (p <0.05). Induction time was shorter in propofol group when compared to dexmedetomidine group (0.79 min vs 10.73 min, p=0.0001). Endoscopist satisfaction is also significantly higher in dexmedetomidine group when compared to propofol group (0.9 vs. 1.82, p =0.0001). CONCLUSION Use of dexmedetomidine was associated with greater haemodynamic stability and faster recovery when compared to propofol. Endoscopists expressed a higher level of satisfaction with dexmedetomidine compared with propofol.

BACKGROUND Postoperative pain forms an acute category of non-malignant pain. Uncontrolled postoperative pain may produce range of detrimental acute and chronic effects. Postoperative epidural analgesia is an effective and well accepted modality of pain relief techniques after abdominal surgeries. The present study is to compare post-operative analgesia with epidural infusion of ropivacaine 0.125%, ropivacaine 0.125% with fentanyl, levobupivacaine 0.125%, levobupivacaine 0.125% with fentanyl for 24 hours in abdominal surgeries. MATERIALS AND METHODS The present study consists of 120 patients who got admitted in Viswabharathi Hospital, Kurnool and underwent abdominal surgeries during October 2014 to October 2015. RESULTS In this clinical study, 120 healthy patients of either sex belonging to ASA grade-I and grade-II were included. The patients were divided into four groups, group A, group B, group C and group D. Group A-Thirty patients received 0.125% Ropivacaine infusion for 24 hours at rate of 8 ml per hour epidurally. Group B-Thirty patients received 0.125% Ropivacaine with fentanyl 1 microgram per ml at the rate of 8 ml per hour infusion for 24 hours epidurally. Group C-Thirty patients received 0.125% Levobupivacaine infusion at the rate of 8 ml per hour for 24 hours epidurally. Group D-Thirty patients received 0.125% Levobupivacaine with fentanyl 1 microgram per ml at the rate of 8 ml per hour for 24 hours epidurally. The study was to compare quality of analgesia, haemodynamic changes, side effects, any associated motor block, amount of local anaesthetic consumed among 0.125% ropivacaine, 0.125% with fentanyl, 0.125% levobupivacaine, 0.125% levobupivacaine with fentanyl when administered as continuous epidural infusion for 24 hours. Analgesia was superior in levobupivacaine with fentanyl infusion and least in plain ropivacaine infusion. Differences in analgesia found in levobupivacaine, ropivacaine with fentanyl and plain levobupivacaine was not clinically significant. CONCLUSION We conclude from present study that levobupivacaine with fentanyl is an attractive option for postoperative epidural analgesia. Ropivacaine with fentanyl and levobupivacaine with fentanyl were of equianalgesic efficacy. Studies with levobupivacaine for postoperative analgesia are limited unlike ropivacaine. From the present study, it was found that plain 0.125% ropivacaine infusion is of lower analgesic efficacy probably due to the shorter duration of action and less potency of ropivacaine.

BACKGROUND Adequate pain management has a great importance for smooth postoperative recovery, early hospital discharge and early rehabilitation. In this study, we compare the analgesic effect and possible side effects of different routes of magnesium sulphate administration in cases of spinal anaesthesia for knee arthroscopy. METHODS This is an experimental prospective randomized control study. 196 patients undergoing knee arthroscopy were divided into 4 groups (49 each): Group A: Given bupivacaine intrathecally during spinal anaesthesia. Group B: Given magnesium sulphate 50 mg with bupivacaine intrathecally. Group C: Given magnesium sulphate IV 10 min after intrathecal injection (30 mg/kg MgSo4). Group D: Given magnesium sulphate intra-articular route, 10 min before the end of surgery (800 mgSo4 diluted in 12 ml normal saline (0.9 % NaCl). Operative time in minutes, VAS at rest and after procedure, time lapse before first analgesic dose after surgery, total dose of rescue analgesics used, pulse rate, mean arterial pressure and side effects were observed and analysed. RESULTS In regards to the lapse of time between end of surgery and first rescue analgesic given, total doses of tramadol used during the 24 hours after the procedure were significantly better in patients given intra-articular magnesium sulphate than other groups (P = 0.001). Patients of Group C who received IV magnesium sulphate were significantly better than patients who were given intrathecal magnesium sulphate in relation to time taken from end of surgery until first analgesic dose. VAS at rest and during the period of first 24 hours followed by surgery was statistically significant in patients who received intra-articular magnesium sulphate (p- 0.001). CONCLUSIONS Intra-articular administration of magnesium sulphate was observed to be superior to other routes of administration or not using at all. Next to intra-articular route, intravenous magnesium sulphate was found to be superior to intrathecal route in providing post operative analgesia in arthroscopy patients. KEY WORDS Analgesia, Knee Arthroscopy, Pain, Magnesium Sulphate, Intrathecal, Intra-articular

BACKGROUND Bupivacaine being an amide is used in hyperbaric and isobaric forms as a spinal anaesthetic for surgeries requiring regional anaesthesia. Spinal anaesthesia is an accepted form of anaesthesia for elective and emergency caesarean sections. Bupivacaine used in spinal anaesthesia produces analgesia, anaesthesia, and motor block. Grading the effects of the anaesthetic is based on volume, concentration, and dose. The present study analysed the role of both types of bupivacaine supplemented by fentanyl. Here we wanted to study the anaesthetic effects of isobaric levobupivacaine versus hyperbaric bupivacaine where both were supplemented by fentanyl while being used as a spinal anaesthetic in patients operated for caesarean section. METHODS A prospective double-blind study was conducted on 104 women undergoing caesarean sections under spinal anaesthesia at Viswabharathi Medical College, RT Nagar, Penchikalapadu, Kurnool. Women with gestational age of above 37 weeks were included. Patients were classified into Group A: levobupivacaine 10 mg 0.5 % in 2 ml with fentanyl 25 μg in 0.5 ml used intrathecally; Group B: Hyperbaric bupivacaine 10 mg 0.5 % in 2 ml with fentanyl 25 μg in 0.5 ml used intrathecally. The time for maximum sensory block, time regression of sensory block to two dermatomes, the time taken to r for regression from maximum to T12 were recorded. A Bromage scale (modified) helped to assess the motor block. Time taken for onset of motor block, the time taken to reach Bromage 3 and the time of complete disappearance were recorded. RESULTS The onset of sensory block was late in group A compared to group B. The time taken to reach the T10 sensory block was shorter in group B compared to group A, the time taken to reach T4 was longer in group A and shorter in group B. The time for regression of two dermatomes was longer in group B when compared to group A. The total duration of sensory blockade was longer in group B than in group A. The time of onset of motor block in Group B was shorter than in Group A. CONCLUSIONS Both levobupivacaine and hyperbaric bupivacaine provided quick and desirable induction of surgical anaesthesia for caesarean operations in full-term pregnant women. They did not cause adverse effects on hemodynamic homeostasis and the neonates. KEY WORDS Spinal Anaesthesia, Local Anaesthetic, Fentanyl, Bupivacaine, Motor Block, Sensory Block.