BACKGROUND: To assess the efficacy of rectal diclofenac suppository in patients undergoing elective laparoscopic cholecystectomy surgeries in management of postoperative pain, in reduction of intra operative opioid requirement and in prolongation of postoperative analgesic initiation time. OBJECTIVES: This prospective randomized single blinded clinical trial evaluates the efficacy of rectal diclofenac suppository for the management of postoperative pain. MATERIALS AND METHODS: 100 patients undergoing elective laparoscopic cholecystectomy surgeries were randomized into two groups, Group 1 patients receiving 100mg diclofenac rectal suppository after induction of general anaesthesia, Group 2 patients does not receive any diclofenac rectal suppository. Intra operative hemodynamic monitoring, post-operative VAS score and adverse reactions were recorded over period of 24 hrs. Intra operative opioid (fentanyl) was repeated when heart rate and blood pressure variability of more than 20% from base line are noted. Post operatively if VAS score is more than 4 rescue analgesia with inj. Tramadol is given intramuscularly. RESULTS: Administration of single dose of rectal diclofenac had statistically significant reduction in VAS score post operatively compared to control group, reduced requirement of intra operative opioids (fentanyl). Post-operative rescue analgesia initiation time is prolonged in group 1 mean 9.56 hrs compared to group 2, mean 0.72 hrs (p-0.000). CONCLUSION: Rectal Diclofenac used in laparoscopic cholecystectomy cases provide adequate, effective prolonged analgesia in the post-operative period with good safety profile.

To evaluate the efficacy of plain ropivacaine 0.25% with that of ropivacaine 0.25% and clonidine 2µg/kg for post-operative analgesia caudally in paediatric patients undergoing subumblical surgeries. MATERIALS AND METHODS: 50 paediatric patients aged between 2-9 years of ASA-I and II, divided into two groups. After giving GA, caudal block is performed in both the groups for post-operative analgesia. Group A receiving plain ropivacaine 0.25%, Group B receiving ropivacaine 0.25% and clonidine 2µg/kg, duration of analgesia, requirement of rescue medication, sedation score, hemodynamic effects and any adverse effects are compared between the two groups. RESULTS: Mean duration of analgesia in Group A is 484.04 minutes, In Group B with addition of clonidine is 771.12 minutes. No of doses of rescue medication required Group A 12 patients required single dose and 2 doses in 8 patients, In Group B 7 patients required single dose and one patient required 2 doses. CONCLUSION: Clonidine as an adjunct to ropivacaine prolongs the duration of analgesia decrease the need of postoperative rescue analgesia with stable hemodynamics.

AIM:To compare the attenuation of haemodynamic changes to laryngoscopy and intubation with IV bolus Esmolol 2mg/kg and IV Fentanyl 2µg/kg. METHODS: 90 adult patients of both sex between age 18 and 55 years with ASA grade I and II normotensive with normal rhythm in ECG are divided randomly into three groups. Group-C was control group. In these patients no drug was given. Group-E was Esmolol group. In this group patients were given Inj. Esmolol-2mg/kg IV 3 min. before intubation over 30 seconds Group-F was Fentanyl group. In this group patients were given Inj. Fentanyl-2µg/kg IV 3 min. before intubation over 30 seconds. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded as baseline and after administration of study drug. RESULTS: Heart rate, systolic, diastolic blood pressures and mean arterial blood pressures were compared at pre op, 1 minute after induction and 1, 3, 5 and 10 minute intervals from the onset of laryngoscopy and intubation. Esmolol showed better attenuation of sympathetic response which is statistically highly significant. It remains significant till the end of 5 minutes. CONCLUSION: Esmolol is more effective than Fentanyl in attenuation of sympathetic response to laryngoscopy and intubation. IV. bolus dose of Esmolol 2mg/kg administered 3 minutes before laryngoscopy and intubation can be recommended to attenuate the sympathetic response to laryngoscopy and intubation without any side effects of the drug.