Introduction: The pain after Laparoscopic Cholecystectomy (LC) which has both somatic and visceral component. Interfascial plane blocks play a major role in Multimodal Analgesia (MMA). Previous studies have found good analgesic benefits with Erector Spinae Plane (ESP) and Oblique Subcostal Transversus Abdominis Plane (OSTAP) blocks. However, till date no study exists which compares the above blocks with addition of dexamethasone. Aim: To compare ESP with OSTAP block using low concentration of Local Anaesthetic (LA) and dexamethasone as part of MMA in elective LC. Materials and Methods: A total of 66 patients were included in this study and finally, 60 patients were analysed. They were randomised to receive either bilateral ESP at T7 level or bilateral OSTAP with 20 mL 0.2% ropivacaine and 4 mg dexamethasone before starting anaesthesia. Primary outcome measures were total opioid consumption and mean Visual Analog Scale (VAS) in the first 24 hours postoperatively. Secondary outcome measures were intraoperative opioid consumption, opioids or block related complication, and patients’ feedback for procedural satisfaction and postoperative pain control. The results were analysed using the Statistical Package for the Social Sciences (SPSS) software version 23.0. Continuous and categorical data were analysed using appropriate statistical analysis. A p-value <0.05 was considered statistically significant. Results: Both the blocks provided excellent pain relief. The mean (24 hours) opioid consumption in ESP group was 29.83±54.74 mg and in OSTAP group was 73.17±94.04 mg; p=0.034. The mean VAS was significantly lower in the ESP block at all point of time during first 24 hours in ESP group was 0.58 and in OSTAP group was 1.72 (p<0.001). The mean intraoperative opioid requirement in ESP and OSTAP group were 6.9±1.8 mg and 7.6±2.3 mg of nalbuphine, respectively. No complications were noted in any patients. Conclusion: Addition of dexamethasone in ESP block provides significant analgesia and less opioid consumption in patients undergoing LC. Hence, ESP block can be considered as part of MMA in LC surgery.

COVID-19 infection in newborn is uncommon, and there is doubt regarding vertical transmission of COVID-19 from an infected mother. We report a preterm neonate born to a mother with HELLP syndrome and COVID-19 pneumonia, who was COVID-19 positive (RT-PCR of tracheal aspirate) at 12 hours of age.

The clavicle is a frequently fractured bone with an infrequent bilateral occurrence. Regional anesthesia (RA) for clavicle surgeries is always challenging due to its complex innervation arising from the two plexuses (cervical and brachial). Various RA techniques described for clavicle surgeries include plexus blocks, fascial plane blocks, and truncal blocks. Plexus blocks are associated with undesirable effects, such as phrenic nerve blockade and paralysis of the entire upper limb, limiting their application for bilateral regional clavicle surgeries. The clavipectoral fascial plane block (CPB) is a novel, procedure-specific, phrenic-sparing, and motor-sparing RA technique that can provide anesthesia or analgesia for clavicle surgeries. The decision to use the CPB and/or other RA techniques may depend on the site of clavicle injury or variations in clavicular innervation.We report a case of single-stage bilateral clavicle surgery successfully managed with a bilateral CPB alone using ultrasound guidance and landmark guidance separately. The patient was kept awake and comfortable throughout the surgery.In conclusion, CPB can be an effective alternate RA technique in avoiding undesired side effects of more proximal techniques such as phrenic nerve involvement and motor blockade of upper limbs. Landmarkguided CPB can be an alternative with equianalgesic efficacy as of ultrasound-guided CPB in resource-poor or emergency settings.

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