Effective analgesia is desirable in ambulatory surgeries. Oblique subcostal transversus abdominis plane block is a good option for providing post-operative analgesia. Dexmedetomidine used as an adjuvant with local anaesthetic results in a longer lasting analgesia and reduces the post-operative opiod supplementation. This helps in early ambulation and early discharge of the patient. The objective of this study was to assess the efficacy of adding dexmedetomidine to 0.25% bupivacaine in bilateral ultrasound guided oblique subcostal transversus abdominis plane block in patients undergoing laparoscopic ovarian cystectomy. METHODOne hundred patients posted for laparoscopic ovarian cystectomy were randomly allocated in two groups of 50 each: group BD received bilateral 20ml 0.25% bupivacaine and 0.5mcg/kg (2ml) of dexmedetomidine; while Group B received 20ml 0.25% bupivacaine and 2ml normal saline. We assessed pain by VAS every 2 hours for 24 hours, time for first analgesic, i.e. morphine demand and totally used morphine doses for 24 hours. Adverse effects were also noted. It was a double blinded study. RESULTSThere is a statistically significant difference in the time for first morphine and pain score for 24 hours between the two methods (p value< 0.05). The time for the first demand of rescue analgesia i.e. morphine was earlier in group B, 5.91±1.28 hours as compared to group BD, i.e. 10.18±2.12 hours. The total morphine consumption in 24 hours (p value < 0.05). The average VAS score for the 24 hours was lower in group BD 3.20±0.579 than in group B, i.e.4.91±1.63. (p <0.05). CONCLUSIONSUltrasound guided oblique subcostal block using dexmedetomidine with bupivacaine provides longer analgesia with significant morphine sparing effect.

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Two groups of 30 patients of ASA 1 and 2 were randomly selected to compare intubation success rates through intubating laryngeal mask airway (ILMA) using conventional polyvinyl chloride (PVC) endotracheal (ET) tube (Group E) and the ET tube provided with ILMA set (Group I) in Mallampati (MP) 3 and 4 patients. Successful intubation in first attempt in Group E patients 15/30 (50%) was less compared to 21/30 (70%) in Group I patients. Incidence of sore throat was higher in Group E patients 12/30 (40%) compared to Group I patients 2/30 (6.67%). Time taken for intubation was longer with PVC tube compared to ILMA tube. Trauma and pilot balloon entanglement was observed with PVC tube. Incidence of esophageal intubation was high in patients intubated with ILMA tube. ILMA tube is economical than conventional PVC tube. ILMA is one of the techniques to manage difficult intubation and not a solution in all difficult intubations.