Background: Pain is the commonest symptom encountered postoperatively and hence multimodal analgesia is tried to overcome it. In this study, we have compared bupivacaine and bupivacaine plus clonidine in transversus abdominis plane (TAP) block for postoperative analgesia in patients undergoing lower abdominal surgeries under spinal anaesthesia. Methods: Sixty ASA I and II patients in the age range of 18-60 years undergoing various lower abdominal surgeries were randomly divided into two groups, who were operated after giving spinal block using 2.5 ml of 0.5% hyperbaric bupivacine and 25ug of fentanyl. At the end of surgical procedure tranversus abdominis plane (TAP) block was given by giving 25 ml of injection bupivacaine 0.25% in group I and 25 ml of 0.25% of bupivacaine with 1 ug.kg-1 of clonidine in group II. Quality of analgesia was assessed by visual analogue scale (VAS), categorical pain scoring system and frequency of rescue analgesia given and duration was assessed with the time at which first rescue analgesia was given. Side effects of clonidine such as sedation, bradycardia and hypotension were also noted. The hemodynamic parameters like heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were noted for both the groups. Results: Demographic characteristics like age, weight, sex, ASA class and type of surgeries were comparable in both groups. SBP, DBP and HR were less in group II than in group I and was statistically significant (p-value<0.05). The overall mean VAS score in group I was 3.03 ± 1.57 and group II was 1.72 ± 1.02 with p-value of 0.0005 and hence better quality of analgesia in group II. Categorical pain scoring system also showed statistically better scores in group II than group I. The duration of analgesia which was calculated by mean time for first rescue analgesia in group I was 6.38 ± 2.56 hours and group II was 14.23 ± 4.63 hours with a p-value of <0.0001 and the difference was statistically significant. The mean number of doses of rescue analgesia in group I for the first 24 hours was 1.37 ± 0.89 and in group II was 0.60 ± 0.62 with a p-value of 0.0003 and the difference was statistically significant. Group II patients showed more sedation scores than group I patients (p-value <0.05). None of the patients had any episode of bradycardia or hypotension. Conclusions: Addition of clonidine 1 ug.kg-1 to 25 ml of 0.25% bupivacaine compared to 25 ml of 0.25% bupivacaine alone in tranverse abdominis plane (TAP) block improves quality of analgesia, increases duration of postoperative analgesia and decreases postoperative analgesic requirements with minimal side effects.

after approval by the Institute Ethics Committee. After getting written informed consent from patients, this study was carried out as a controlled, randomized (chit method), double blind, prospective study in 60 patients. Sensory and motor blockade of radial, median, musculocutaneous and ulnar nerves were recorded at regular intervals (at each min till complete blockade) after drug injection. Following observations were noted intra and post operatively. The duration of analgesia or first request for analgesic defined as the time to attain a Visual Analogue Score (VAS) of 4 or >4 after Ropivacaine administration. The VAS was recorded post-operatively every 30min till the score of 4 or >4. Results: Duration of sensory block was significantly longer in group RD as compared to group R (p < 0.001). It was found that duration of motor block increased more with Dexmedetomidine addition (407.33±53.09 min) than with Ropivacaine alone (278.66±44.77 min). There was significant increase in duration of analgesia in group RD (685.33±90.02 min) than with group R (344.00±52.06 min). In RD group 2 patients developed haematoma and only 1 patient develop blood in aspiration due to arterial puncture, and in R group 1 patient develop haematoma and 2 patients developed blood in aspiration. Conclusion:We conclude that Dexmedetomidine is a good adjuvant in supraclavicular brachial plexus block for upper limb surgeries.

To compare dexmedetomidine versus clonidine as the adjuvants with hyperbaric bupivacaine in subarachnoid block for lower limb orthopedic surgeries. Material and method: The present study included 160 patients undergoing lower limb orthopedic surgery under subarachnoid block at Department of anaesthesia, Mahatma Gandhi Missions Institute of Health Sciences, Navi Mumbai, Maharashtra. Randomization was a statistical procedure by which the participants have been allocated into 2 different groups i.e. Group C (Clonidine group) and Group D (Dexmedetomidine group). Time of onset of motor block was assessed using Bromage scale. Analgesia duration was observed and recorded following pain scoring system-Visual analogue score (VAS). Results: It was observed that there was statistically significant difference between the total duration of sensory and motor block of the patient in the both groups. The difference in VAS scores were found to be statistically significant among two groups (p<0.05) at 2 hr, 2.5 hr and 3 hr. Conclusion:We concluded that dexmedetomidine 5µg is the preferred drug, when prolongation of spinal anaesthesia is desired in lower limb orthopedics surgeries.

Background: The focus to improve surgical technique has changed from recurrence to chronic postoperative inguinal pain (CPIP). Nerve injury or stretching due to surgical approach or mesh fixation led to CPIP. Transrectus sheath preperitoneal procedure (TREPP) is a new open technique in which the mesh is placed preperitoneally via medial approach. The goal of this study was to evaluate and compare the results of TREPP with another open anterior approach- Gilbert’s repair which also doesn’t need mesh fixation; in view of operative time, duration of hospital stay, CPIP, recurrence and cost effectiveness.Methods: Between November 2013 and October 2015, an observational clinical study of TREPP and Gilbert’s repair in the treatment of groin hernia was conducted in the department of surgery, SMHS Hospital. Patients were enrolled after detailed history, clinical examination, all baseline investigations.Results: A total of 40 patients above 18 years of age with primary unilateral inguinal hernia were operated: 20 with TREPP and remaining 20 with Gilbert’s technique. Out of those who underwent TREPP 75% had indirect type and 25% had direct type hernia. Similarly, out of those who underwent Gilbert’s repair, 65% had indirect type and 35% had direct hernia. Operative time was significantly lower in TREPP with mean of 58.6±11.47 minutes in comparison to 68.4±9.54 minutes in Gilbert’s repair. Also, the mean hospital stay was 21.2±3.69 hours in TREPP whereas it was 31.2±6.03 hours in Gilbert’s repair.Conclusions: TREPP is a more feasible new technique for inguinal hernia repair with better results in terms of CPIP especially. It is more promising because of the complete preperitoneal view, the short learning curve, and the stay-away-from-the-nerves principle thereby offering better outcome and patient satisfaction.

Patent ductus arteriosus (PDA) is a condition which is