In recent years, many neuraxial techniques have been introduced to initiate and maintain labour analgesia, with low-dose mixtures of local anaesthetics and opioids, which have improved the quality of analgesia and made it safer for both mother and neonate. An independent search of the databases of PubMed, Medline, and Cochrane controlled trial data was conducted by two researchers, and randomized controlled trials that compared different methods of neuraxial analgesia and the different techniques of maintaining labor analgesia were retrieved and analyzed. The advantages, disadvantages, and indications of each technique along with the doses of intrathecal and epidural drugs are discussed. The myths and controversies involving neuraxial labor analgesia and the current consensus on their effect on the maternal and foetal outcomes are also outlined.

No abstract

No abstract

BACKGROUND & AIMSSeveral pre-operative screening tools are used in adult. Wide range of pediatric anatomical & developmental differences (especially with infants) makes uses of adult clinical predictors in challenge. The aim of our study is to assess various measurements of intubation in infants and their correlation with difficult laryngoscopy. MATERIAL AND METHODSThis prospective randomized study conducted in 100 infants. We assessed the usefulness of neck length (NL), neck circumference (NC), Head Circumference, (HC) ratio of NC/NL and introduced length of laryngoscope blade as predictors of difficult laryngoscopy and intubation. RESULTNC, NL, HC and ratio of NC/NL were significantly associated with incidence of difficult laryngoscopy and intubation. As this ratio increases difficulty at laryngoscopy increases (p<.001). Difficult laryngoscopy was assessed using Cormack Lehane grading. We found as age increases laryngoscopy becomes easier. (p<0.05) CONCLUSIONThere is no single anatomical measurement of intubation in infants in our study we measured NC, NL, NC/NL, HC and introduced length of laryngoscope blade which were found to be important predictors of difficult laryngoscopy and intubation. Statistical significant correlation was found between age and Cormack Lehane grades. In infants, various congenital malformations are highly associated with difficult laryngoscopy and intubation.

Background: Wound infiltration with local anaesthetic is safe and effective technique for providing postoperative analgesia following lumbar laminectomy. The objective of this study was to compare the efficacy of local wound infiltration on postoperative analgesia with levobupivacaine, levobupivacaine plus magnesium sulphate and levobupivacaine plus dexmedetomidine in patient undergoing lumbar laminectomy.Methods: Ninety adult patients were randomly allocated into three groups. After the completion of lumbar laminectomy, the drug was locally infiltrated into the paravertebral muscles on either side. Group L received 10 ml of 0.5% levobupivacaine plus 10 ml normal saline, group LM received 10 ml of 0.5% levobupivacaine plus 500 mg magnesium sulphate (1 ml) plus 9 ml normal saline, group LD received 10 ml of 0.5% levobupivacaine plus 50 µg dexmedetomidine (0.5 ml) plus 9.5 ml normal saline. Postoperative visual analogue scale (VAS) pain score at 0, 1, 2, 4, 6, 8, 12 and 24 hours, time to first rescue analgesic drug and its total dose, quality of recovery score (QoR) and side effects were noted.Results: Postoperative VAS was significantly higher in group L as compared to group LM and LD (p<0.05). The time to first rescue analgesic drug was significantly longer in group LD (11.07±7.20 hr) than group LM (6.20±2.64 hr) and group L (3.93±2.70 hr) (p<0.001). The QoR score was significantly better in group LD as compared to group LM and L postoperatively (<0.01).Conclusions: Addition of magnesium sulphate or dexmedetomidine to levobupivacaine for local wound infiltration demonstrated enhanced postoperative analgesia.