BACKGROUND:The prime duty of any anesthesiologist is to relive pain in the perioperative period. Today regional anesthesia is well established as equal to general anesthesia in effectiveness and patient acceptability. Regional anesthesia is blocking of peripheral nerve conduction in a reversible way using local anesthetic agents. For surgeries on upper extremities, particularly in emergency surgeries, regional anesthesia has many advantages over general anesthesia. The brachial plexus is approached at the level of trunks and the compact arrangement of trunks at the supraclavicular level gives a high success rate with minimum local anesthetic drug volume and a dense and fast onset of the block. To prolong the duration of analgesia various drugs have been studied as adjuvants to the local anesthetics. This study is intended to determine the effects of adding Clonidine to Bupivacaine in brachial plexus blockade by Nerve locator assisted supraclavicular approach, with regard to the onset, intensity and duration of blockade along with its analgesic efficacy. METHODS: Forty adult patients of both sexes in the age group of 20-60 years of weight ranging from 50-70kg belonging to ASA I/II category posted for various types of upper limb surgeries the patients were randomly allocated into two groups,. Supraclavicular brachial plexus block was performed via peripheral nerve locator assisted subclavian perivascular technique. Group -B (Bupivacaine alone)-20 patients received 30ml of 0.375%Bupivacaine with 2ml of 0.9% sodium chloride solution. Group-BC (Bupivacaine+Clonidine)-20 patients received 30ml of 0.375%Bupivacaine with Clonidine hydrochloride 100μg (1ml of 150μg diluted with 2ml 0.9% NaCl solution. From that 2ml used for study. (The following parameters are assessed Onset of blockade, Duration of blockade, Intensity of blockade, Sedation, Quality of analgesia, Haemodynamic changes & Complications if any RESULTS: Onset time for both motor and sensory block was quicker in the Bupivacaine with clonidine group, Time taken for completion of both motor and sensory blockade was, significantly lesser in clonidine group, There was no difference between the groups in the intensity of blockade., The mean duration of both sensory & motor blockade was significantly prolonged in clonidine group, Sedation was statistically significant with Bupivacaine-clonidine group in the intraoperative period, There was no haemodynamic instability in both the groups in the study period, There was no complication due to the addition of 100μg clonidine to Bupivacaine CONCLUSION: clonidine 100μg (in 2ml)when used as an additive to 0.375% Bupivacaine(30ml) solution for Supraclavicular brachial plexus block, quickens the onset of sensory & motor blockade and prolongs the duration of sensory & motor blockade. It also improves the quality of post-operative analgesia with mild intraoperative sedation and decreases the heart rate without any haemodynamic instability. Hence, clonidine can be considered as a safe additive to local anaesthetic solu...

ABSTRACT:The term unilateral spinal anaesthesia is used when block is off operating side only and the operative side will be dependent side and absence of block on non-operative i. e. nondependent side. So when surgery involving in one limb, especially below knee surgery such block is very advantageous as it minimizes cardiovascular effects, avoids motor block of non-operative limb and facilitates early discharge. For this purpose we used 1.2ml of (6mg) of hyper baric Bupivacaine 0.5%+0.2ml (10microgram) of fentanyl to produce exclusively unilateral spinal anaesthesia. CASE REPORT: A 62 years old obese patient (80Kgs), 5 feet 10 inch height patient with known history of hypertension and diabetes mellitus posted for below knee orthopedic surgery (Bimalleolar Screws + Fibular plating). This patients 2D Echo showed chance finding of atrial septal defect (ASD) of ostium secundum type with 26mm in size and asymptomatic with left to right shunt. Ejection fraction is 48%. CONCLUSION: In this case we used 0.5% Bupivacaine 1.2ml (6mg) and 0.2ml of fentanyl (10microgram) which has provided predominantly unilateral block. 15-20 minutes taken to keep the patient in lateral decubitus position to establish the block completely. The advantages are hemodynamic stability, patient satisfaction and faster anaesthesia recovery.