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Ultrasound guidederector spinae plane (ESP) block is effective in thoracoabdominal surgeries for control of postoperative pain. With the increasing use of adjuvants in local anesthetics, the block duration can be prolonged. A 21 year old female patient diagnosed with mediastinal teratoma was planned for resection of tumour through median sternotomy. She was given general anaesthesia with standard drugs. At the end of surgery, patient was given bilateral ultrasound guided ESP block with 10 ml of injection ropivacaine 0.2% with 50 mg tramadol at T5 level on each side. Visual analogue scores (VAS) were in the range of 2-3 for first 24 hours and 1 from 24-48 hours. Patient didn't demand any analgesic in postoperative period for first 48 hours and was completely painfree. Severe postoperative pain of sternotomy can be controlled effectively by giving ultrasound guided ESP block. Moreover, tramadol is a useful adjuvant to prolong the block duration upto 48 hours.

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Hypocalcaemic cardiomyopathy is a rare postoperative complication after hemi-parathyroidectomy which reverses completely on the restoration of normocalcaemia. Patients of Turner syndrome have subtle cardiovascular anomalies due to the underlying oestrogen deciency. A 16-year-old female patient with Turner syndrome underwent hemi-parathyroidectomy for parathyroid adenoma. The patient developed signs of heart failure on postoperative day two, which was precipitated by tachycardia due to fever. She developed tachycardia, tachypnoea, hypertension, and pulmonary oedema with an ejection fraction of 20-30% at the time without any underlying cardiac disease. The patient was managed with intravenous diuretics, beta-blockers, and non-invasive ventilation. Other probable causes such as sepsis, pheochromocytoma, thyrotoxicosis, and Takotsubo syndrome were ruled out. A differential diagnosis of hypocalcaemic cardiomyopathy was suspected, and the patient was given intravenous calcium and vitamin-D supplementation. The patient responded promptly to restoration of normocalcaemia, and the cardiomyopathy reversed completely. Echocardiography done on follow-up showed normal ejection fraction.