AIM:Our aim is to evaluate the role of Nalbuphine as an additive to Bupivacaine to increase the duration of analgesia postoperatively by epidural anaesthesia. METHODS: 60 patients randomly allocated into two groups, 30 patients in each of both sexes ranging from 18-50 yrs age group of ASA grade I and II, posted for lower abdominal surgeries using 0.2mg/kg of Nalbuphine (Made to 1ml) with 0.5% Bupivacaine 19ml in study group epidurally with control group 0.5% Bupivacaine with 1ml of normal saline. RESULT: Epidural Nalbuphine produces early onset of sensory blockade significantly at 3.23±0.97mins (Control group 15.30±2.97mins), and prolongs the duration of postoperative analgesia significantly up to 449.67±39.43mins. (Control group 185.93± 32.43mins). CONCLUSION: In conclusion epidural Nalbuphine 0.2mg/kg with 0.5% Bupivacaine produces early onset of analgesia and prolonged duration of analgesia compared with 0.5% Bupivacaine with Normal saline.

BACKGROUND: Awake craniotomy is an important technique used for brain tumour excision from eloquent cortex. Awake craniotomy allows maximum resection of the tumor with minimum functional impairment. The critical aspect is to maintain adequate analgesia and sedation, hemodynamic stability, airway safety, while keeping the patient awake and cooperative for neurological testing. AIM OF THE STUDY: We are reporting cases series of awake craniotomy under monitored anesthesia care using dexmedetomidine infusion as an adjuvant to scalp block, titrating the sedation level by BIS monitoring. MATERIALS AND METHODS: After careful patient selection and psychological preparation Monitored Anesthesia Care was provided by continuous infusion of dexmedetomidine at a rate of 0.2-0.5ug/kg/min titrating sedation score to BIS value of 70-90. Bilateral scalp block was administered using 0.5% bupivacaine. For dura mater incision, a pad with 2% lidocaine was applied for 3 minutes. The tumor removal was complete with no neurological deficiency. All the patients were discharged on 5 th postoperative day without complications and with full patient satisfaction. CONCLUSION: We conclude that monitored anesthesia care with dexmedetomidine infusion and scalp block for awake craniotomy is safe and efficacious. Absence of complications and high patient satisfaction score makes this technique close to an ideal technique for awake craniotomy.