A 9 month old child presented with a growth in the oropharynx for removal. Only complaint was distressed breathing on crying. It turned out to be a case of difficult paediatric airway that was managed well. A diagnoses of oesophageal fibro-epithelial polyp was made after histopathological examination.

Ropivacaine, a local anesthetic agent with similar pharmacological profile to that of bupivacaine has lower potential for toxic effect. The aim of our study is to compare the anesthetic characteristics of ropivacaine and bupivacaine when used for supraclavicular brachial plexus blockade in upper limb surgeries. Fifty patients was grouped equally and one group R received 0.5% ropivacaine (100mg) 20ml and another group B received 0.5% bupivacaine (100mg) 20ml. onset & duration of sensory and motor blockade, duration of analgesia and associated complications & side effects were recorded. It was found that there were no significant differences in duration of sensory & motor blockade, in complications or any other side effects in both the groups. But ropivacaine provided rapid onset of action and better quality of surgical anesthesia than bupivacaine when used in supraclavicular brachial plexus blockade.

BACKGROUND:The addition of clonidine as an adjuvant has allowed the use of lower concentration of the local anaesthetic for achieving the same level of anaesthesia but with the prolonged duration of analgesia which increases the margin of safety and reduces the incidence of unwanted motor blockades. With these facts in mind we undertook the study to compare the analgesic properties of 0.25% ropivacaine with the addition of clonidine (1µg/kg) to that of ropivacaine 0.25% following caudal administration in children. METHODS: After approval from ethical committee 60 children of age 1-10 yrs of ASA grade I or II undergoing elective sub umbilical surgeries were selected for the study. We gave caudal block with 0.25% ropivacaine 1ml/kg+1ml normal saline for group R or 0.25% ropivacaine 1ml/kg + clonidine 1microgram/kg+1ml normal saline to make volume 1ml for group C. To perform caudal block all patient received IV injection glycopyrolate-0.01mg/kg, IV injection midazolam-0.1mg/kg and IV Injection ketamine-1mg/kg. Hemodynamic parameters were observed before, during and after the surgical procedure. Quality of surgical anesthesia & requirement of supplemental midazolam/ketamine were also noted. Duration of Post-operative analgesia, pain scores, level of sedation and side effects if any were looked for and duly recorded. RESULT: Duration of analgesia in group R was 6.45±0.52 hrs. and in group C was 13.01±0.89hrs i.e. significantly prolonged in group C (P<0.0001). Post-operative pain score and sedation score were also significantly better in group C (P<0.0001). The quality of surgical analgesia was also significantly excellent in group C. Other vital parameters were not statistically significant in both the groups. CONCLUSION: Ropivacaine (0.25%) with clonidine (1μg/kg) in caudal block showed prolong duration of analgesia as well as better quality of surgical anaesthesia than plain ropivacaine (0.25%) in pediatric patients without any significant side effects.