Background and Aims: Subarachnoid block is the most commonly used anaesthesia technique for lower limb surgeries. Opioids are the most commonly used adjuvants with local anesthetics (LA). Adjuvants are given premixed with LA loaded in a single syringe. This study was conducted to evaluate differences in level of sensory and motor block and incidence of hypotension whilst administering hyperbaric bupivacaine and fentanyl either in a single syringe or different syringes. The effect of administering opioid prior to LA and vice versa on these parameters was also assessed. Methods: One hundred and twenty patients were randomly allocated into three groups of 40 each: Group A received premixed 0.5% heavy bupivacaine 2.5 ml (12.5 mg) and 0.5 ml (25 microgram) of fentanyl in a single 3.0 ml syringe, Group B received 0.5 ml (25 microgram) of fentanyl in a 3.0 ml syringe followed by 0.5% heavy bupivacaine 2.5 ml (12.5 mg) in a 3.0 ml syringe, Group C received 0.5% heavy bupivacaine 2.5 ml (12.5 mg) in a 3.0 ml syringe followed by 0.5 ml (25 microgram) fentanyl in a 3.0 ml syringe. All statistical calculations were done using SPSS 21 version statistical program for Microsoft Windows. Results: The mean time for onset of sensory and motor block was least in group C followed by group B. The duration of sensory and motor block was prolonged in groups B and C. Patients in group A experienced more hypotension as compared to groups B and C. Conclusion: Administering hyperbaric bupivacaine first followed by fentanyl leads to an early onset and prolonged duration of sensory and motor block.

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<p class="abstract"><strong>Background:</strong> Deep neck space infection (DNSI) is the infection of the potential spaces in the neck, specifically around the facial planes. Management of DNSI is traditionally by prompt surgical drainage of the abscess followed by antibiotics. In select cases, nonsurgical treatment using appropriate antibiotics may be employed. The objective of this study was to review the clinical profile of patients with DNSI.</p><p class="abstract"><strong>Methods:</strong> This was a retrospective chart review of 62 patients of DNSI managed at a tertiary care hospital of North India. Various parameters assessed in study included the demographical profile of the patients, symptomatology, possible aetiology, site distribution, bacteriology, the co-morbid conditions and treatment received.  </p><p class="abstract"><strong>Results:</strong> Male preponderance was seen in this study with male:female ratio of 1.69:1. Swelling was the main complaint in majority of the patients (91.9%, 57 of 62 patients). The most common aetiology was odontogenic infection. Diabetes mellitus was seen in 25.8% (n=16) patients. Multiple space involvement was seen in majority of the patients with submandibular space being the most commonly involved site (43.5%). Most patients had negative pus cultures. The most common organism isolated was <em>Staphylococcus aureus</em>. All patients underwent surgical drainage.</p><p class="abstract"><strong>Conclusions:</strong> Odontogenic pathology is the most common cause related to DNSI. So extreme caution should be exercised by dentists in diabetic patients and in those with other immunocompromised status. Pus culture should be obtained before the start of antimicrobial therapy. If not diagnosed and treated in time, DNSI can turn out to be fatal.</p>

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