Background: Functional endoscopic sinus surgery (FESS) is a surgical intervention for sinus diseases. Bleeding is a common concern during FESS. Hemodynamic stability and quality surgical field visibility help to achieve the best outcomes. Objectives: The present study primarily intended to compare the effectiveness of dexmedetomidine versus labetalol in providing controlled hypotension during FESS and then to assess the quality of the surgical field. Methods: The current research was conducted as a prospective randomized double-blinded clinical study. Sixty patients of the American Society of Anesthesiologists grade I or II status undergoing FESS under general anesthesia were divided into two groups, each with 30 members. Patients receiving dexmedetomidine and labetalol were named as group D and L, respectively. The study intended to manage mean arterial pressure (MAP) between 65 - 75 mmHg. The visibility of the operative field was evaluated using Fromme and Boezaart scoring system. Total intraoperative fentanyl consumption and postoperative first analgesic request time were recorded. Results: The MAP target was achieved in both groups. Intergroup differences concerning MAP were observed in both D (75.0 ± 2.0) and L (82.4 ± 5.2) groups (P-value < 0.05). Scores for blood loss were significantly lower in the D group (1.3 ± 0.3) compared to the L group (2.1 ± 0.3) (P-value < 0.05). There was no intergroup difference concerning the mean heart rate (group D; 70.8 ± 4.2, and group L; 73.4 ± 4.4). The total dose of fentanyl consumed was found to be significantly lower in the group D (41.9 ± 5.8) compared to group L (59.9 ± 5.3) (P-value < 0.05). The first analgesic request time was significantly longer in the group D (50.2 ± 9.1) compared to group L (24.8 ± 5.1) (P-value < 0.05). Conclusions: Dexmedetomidine provided better hemodynamic stability and operative field visibility as compared to labetalol during FESS.

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Background: Postoperative analgesia is of utmost importance in the treatment of patients undergoing surgery. Good postoperative pain management reduces hospital stay and improves early ambulation. This study compared the efficacy of epidural bupivacaine with buprenorphine to butorphanol in lower limb orthopedic surgery. Objectives: This study was carried out to investigate the onset of analgesia, the extent of analgesia, sedation score, and side effects of butorphanol with bupivacaine versus buprenorphine with bupivacaine. Methods: In a clinical trial study, 100 patients who underwent elective orthopedic lower limb surgery were randomly allocated to two groups. A total of 100 patients with American Society of anesthesiologists grades I and II posted for lower limb orthopedic surgery were enrolled in this randomized, double-blind study. The patients were divided into groups A and B. Subarachnoid block was achieved with 3.4 mL of 0.5% bupivacaine. The pain was monitored by the visual analog scale postoperatively. The patients in group A received bupivacaine with buprenorphine, and group B received bupivacaine with butorphanol when they complained of pain in the postoperative period. The onset of analgesia, duration of analgesia, sedation score, and side effects were compared between the two groups. Results: The onset of analgesia was observed earlier in group A than in group B (7.7 ± 1.6 vs. 12.6 ± 1.7 minutes, P < 0.001). The duration of analgesia was longer in group A than in group B (590 ± 40 vs. 480 ± 54 minutes, P < 0.001). Pulse rates and mean arterial pressures were significantly different (P < 0.001). Side effects were common in both groups. Conclusions: Buprenorphine added to bupivacaine provides earlier onset and longer postoperative epidural analgesia than epidural butorphanol with bupivacaine.

BACKGROUND: In the present day practice of anaesthesia, bupivacaine is the most commonly used drug for spinal anaesthesia. To improve the quality of analgesia and prolong the duration of anaesthesia many adjuvants have been used namely Neostigmine, Clonidine, Propofol. The new α2 agonist dexmedetomidine has been proved to prolong the spinal anaesthesia. We hypothesized that dexmedetomidine when administered intravenously as an adjuvant to spinal anaesthesia prolongs spinal analgesia. METHODS: 90 patients of ASA grade I & II were randomly allocated into two equal groups namely Group A and Group B. Group A received 3.5ml of 0.5% hyperbaric bupivacaine. Group B received 3.5ml of 0.5% hyperbaric bupivacaine followed by loading dose of 1µg/kg of dexmeditomedine intravenously 30mins after the subarachnoid block and maintenance infusion dose of 0.5µg/kg/hr till the end of surgery. Patient in Group A received normal saline. The regression to reach S1 sensory level and Bromage 0 (zero) motor scale, haemodynamic changes and level of sedation were recorded. RESULTS: The duration of sensory block was 246.33±51.41 min in Group B as compared to Group A (176.89±34.22). The duration of sensory block was longer in Group B. The duration of motor blockade was longer in Group B than Group A (193.33±34.24 Vs 159.78±23.52). Bradycardia and hypotension was more in Group B than Group A but was not significant

The postoperative period is an integral part of the surgical experience of the patient. Post-operative pain affects recovery from anaesthesia and surgery. Pre-emptive use of gabapentin speeds up recovery by decreasing post-operative pain.The objectives of the study were to evaluate the effect of oral gabapentin on post-operative pain scores, the request time for first analgesia and the total fentanyl requirement in 12 hours in patient undergoing total abdominal hysterectomy under epidural anaesthesia.: Eighty four patient of ASA grade I and II aged 40 to 60 years, scheduled for total abdominal hysterectomy under epidural anaesthesia were included in the study. Each patient was assigned into two groups (Gabapentin group, group G or Placebo group, group P) of 42 each. Participants in the study were administered 2 capsules (either gabapentin or placebo) one hour before surgery with sips of water. 15ml of Ropivacaine 0.75% was administered into epidural space through 20 gauge epidural catheter. Pain was evaluated post-operatively using visual analogue scale (VAS). Inj. Fentanyl 30 mcg was administered through epidural catheter as rescue analgesia when patients complained of pain.: It was observed that Pain scores were notably lesser in group G as compared to group P at all time points (P&#60;0.05). The first analgesic request time in the control group was significantly less compared to the study group (P&#60;0.001). The amount of fentanyl required in the control group was more compared to study group (P&#60;0.001).: We conclude that the pre-emptive administration of oral gabapentin 600mg significantly reduces pain scores, prolongs the time at which patient requires rescue analgesia and the amount of fentanyl needed was significantly reduced.