Background and Aims: Induction of general anaesthesia is associated with development of atelectasis in the lungs, which may further lead to postoperative pulmonary complications. Inverse ratio ventilation (IRV) has shown to improve oxygenation and minimise further lung injury in patients with acute respiratory distress syndrome. We evaluated the safety and effectiveness of IRV on intraoperative respiratory mechanics and postoperative pulmonary function tests (PFTs). Methods: In a prospective, controlled study, 128 consecutive patients with normal preoperative PFTs who underwent elective laparoscopic cholecystectomy were randomised into IRV and conventional ventilation groups. Initially, all patients were ventilated with settings of tidal volume 8 mL/kg, respiratory rate 12/min, inspiratory/expiratory ratio (I: E) = 1:2, positive end expiratory pressure = 0. Once the pneumoperitoneum was created, the conventional group patients were continued to be ventilated with same settings. However, in the IRV group, I: E ratio was changed to 2:1. Peak pressure (Ppeak), Plateau pressure (Pplat) and lung compliance were measured. Haemodynamic parameters and arterial blood gas values were also measured. PFTs were repeated in postoperative period. Statistical tool included Chi-square test. Results: There was no significant difference in PFTs in patients who underwent IRV as compared to conventional ventilation [forced vital capacity (FVC) 2.52 ± 0.13 versus 2.63 ± 0.16, P = 0.28]. The Ppeak (cmH2O) and Pplat (cmH2O) were statistically lower in IRV patients [Ppeak 21.4 ± 3.4 versus 22.4 ± 4.2, P = 0.003] [Pplat 18.7 ± 2.4 versus 19.9.4 ± 3.2, P = 0.008]. There was no significant difference in lung compliance and oxygenation intraoperatively. Conclusion: Intraoperative IRV led to reduced airway pressures; however, it did not prevent deterioration of PFTs in postoperative period.

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Background: One of the most common ailments that plagues patients is Low back pain. Approximately 80% of the population developing some form of back pain in their lifetime. Up regulated sodium channels is the basic cause in the nerve root or dorsal root ganglion for the mechano-sensitization. Functionally both ends of the pseudo unipolar neuron are the same hence injecting the drug in the peripheral end of the nerve will block these sodium channels. Methods: Open labelled single group pilot study was conducted on patients reporting at the Pain Clinic of AIIMS, Rishikesh after obtaining consent. In the operation theatre patients received one or two peripheral nerve blocks at a maximum according to their nerve involvement. Outcomes were assessed immediately after injection and at 1st, 2nd, 3rd week after the proposed interventions. Results: 30 patients were included in the study. No procedural complications were noted in these 30 patients as the given dose is very less and the site of injection is peripheral. Significant fall in NRS is observed at every visit. Only two patients reported back to pain clinic without pain relief. Conclusion: Peripheral nerve block injection can be used as adjuvant for acute low back ache which is very simple can be administered in an OPD setting without the help of fluoroscopy guidance. Further studies with control group are needed to establish their efficacy.

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